Assessment of transposition of the great arteries associated with multiple malformations using dual-source computed tomography

PLoS One. 2017 Nov 20;12(11):e0187578. doi: 10.1371/journal.pone.0187578. eCollection 2017.

Abstract

Purpose: To determine the value of dual-source computed tomography (DSCT) in depicting the morphological characteristics and diagnosing the associated malformations for patients with transposition of the great arteries (TGA) before surgery.

Materials and methods: Twenty-five patients with TGA who underwent DSCT and transthoracic echocardiography (TTE) examination were retrospectively reviewed. The morphological types of TGA, the spatial relationship between the pulmonary artery and the aorta, as well as coronary artery-associated abnormalities were assessed by DSCT. In contrast to TTE, the diagnostic accuracy of associated malformations on DSCT were analyzed and calculated with reference to surgical or digital subtraction angiography (DSA) findings. Effective doses (EDs) were also calculated.

Results: Among the 25 patients, 12 (48%) had ventricular septal defects and left ventricular outflow tract stenosis. Sixteen patients (16/25, 64%) had great arteries with an oblique spatial relationship on DSCT. In addition, we found seven patients (7/25, 28%) with coronary artery malformation, including five with an abnormal coronary origin and two with signs of a myocardial bridge. According to DSA or surgical findings, DSCT was superior to TTE in demonstrating extracardiac anomalies (sensitivity, anomalies of great vessels: 100% vs. 93.33%, other anomalies: 100% vs. 46.15%). The mean estimated ED for those aged <10 years was <2 mSv (1.59 ± 0.95 mSv).

Conclusions: DSCT can achieve an overall assessment of patients with TGA, including any associated malformations as well as the identification of the spatial relationship of the great arteries. DSCT can therefore be considered as an alternative imaging modality for surgical decision making.

MeSH terms

  • Adolescent
  • Adult
  • Aorta / diagnostic imaging
  • Aorta / physiopathology
  • Child
  • Child, Preschool
  • Computed Tomography Angiography*
  • Coronary Angiography / methods
  • Coronary Stenosis / diagnostic imaging
  • Coronary Stenosis / physiopathology
  • Echocardiography / methods
  • Female
  • Heart Defects, Congenital / diagnostic imaging
  • Heart Defects, Congenital / physiopathology
  • Heart Defects, Congenital / surgery
  • Heart Septal Defects, Ventricular / diagnostic imaging*
  • Heart Septal Defects, Ventricular / physiopathology
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / physiopathology
  • Humans
  • Infant
  • Male
  • Myocardial Bridging / diagnostic imaging
  • Myocardial Bridging / physiopathology
  • Transposition of Great Vessels / diagnostic imaging*
  • Transposition of Great Vessels / physiopathology
  • Transposition of Great Vessels / surgery
  • Ventricular Outflow Obstruction / diagnostic imaging*
  • Ventricular Outflow Obstruction / physiopathology

Grants and funding

This work was supported by the National Key Research and Development Program of China (2016YFC1300300 to YKG), Program for New Century Excellent Talents in University (No: NCET-13-0386 to YKG), and Program for Young Scholars and Innovative Research Team in Sichuan Province (2017TD0005 to YKG) of China. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.