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Dynamic pulmonary computed tomography angiography: a new standard for evaluation of combined airway and vascular abnormalities in infants

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Abstract

Airway abnormalities are frequently associated with congenital heart disease in infants and children. Respiratory distress in these children frequently requires prolonged respiratory support. Wide-detector dynamic pulmonary computed tomography angiography (DP-CTA) is a non-invasive technique that completely evaluates vascular and airway abnormalities during a single breathe. Our purpose was to evaluate the efficacy of DP-CTA to provide unique actionable information for patient care in newborns and infants with congenital heart disease and persistent respiratory distress. 23 infants with congenital heart disease and persistent respiratory distress underwent DP-CTA. All were intubated at the time of the examinations. The most common cardiac anomalies were tetralogy of Fallot (6) and hypoplastic left heart syndrome variants (5). The most common cardiac surgeries prior to DP-CTA were Norwood (4) and hybrid (3) procedures. The protocol for DP-CTA for intubated infants is four gantry rotations in 1.4 s after intravenous contrast injection. 3D and multiplanar reconstruction with cine loops were created for combined cardiopulmonary imaging. Tracheobronchomalacia was present in 17 children. Lobar bronchomalacia was identified in six children. Branch pulmonary artery stenosis was the most common vascular finding (10 children). Medical management was changed or a surgical procedure performed based on the information resulting from DP-CTA in 16 of the 23 patients (70 %). DP-CTA is non-invasive, fast and provides unique information for the management of infants with congenital heart disease and persistent respiratory distress. DP-CTA is uniquely suited for comprehensive and simultaneous evaluation of airway and vascular abnormalities in infants.

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Authors and Affiliations

  1. Arkansas Children’s Hospital, 1 Children’s Way, Slot #105, Little Rock, AR, 72202, USA

    S. Bruce Greenberg & Umesh Dyamenahalli

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  1. S. Bruce Greenberg
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  2. Umesh Dyamenahalli
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Correspondence to S. Bruce Greenberg.

Electronic supplementary material

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10554_2013_344_MOESM1_ESM.avi

Figure 2 supplemental: The color lit cine loop shows dynamic narrowing of the left bronchus during expiration as the left bronchus passes anterior to the descending aorta. (AVI 6146 kb)

10554_2013_344_MOESM2_ESM.avi

Figure 3 supplemental: The 3D volume rendering cine loop shows severe right upper lobe bronchomalacia resulting from the PDA stent. (AVI 6146 kb)

10554_2013_344_MOESM3_ESM.avi

Figure 4 supplemental: The3D volume rendering shows severe left bronchomalacia associated with the left PDA stent. (AVI 6146 kb)

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Greenberg, S.B., Dyamenahalli, U. Dynamic pulmonary computed tomography angiography: a new standard for evaluation of combined airway and vascular abnormalities in infants. Int J Cardiovasc Imaging 30, 407–414 (2014). https://doi.org/10.1007/s10554-013-0344-1

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  • DOI: https://doi.org/10.1007/s10554-013-0344-1

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