Computed Tomographic Angiography Provides Reliable Coronary Artery Evaluation in Infants With Pulmonary Atresia Intact Ventricular Septum

Semin Thorac Cardiovasc Surg. 2024;36(3):336-344. doi: 10.1053/j.semtcvs.2022.10.003. Epub 2022 Oct 14.

Abstract

Evaluate the use of coronary CTA as an initial assessment for determining Right Ventricle Dependent Coronary Circulation (RVDCC) in neonates with Pulmonary Atresia with Intact Ventricular Septum (PA IVS). Retrospective review of cases with coronary CTA and compare with available catheter angiography, pathology, surgical reports, and outcomes from Mar 2015 to May 2022. In our cohort of 16 patients, 3 were positive for RVDCC, confirmed by pathologic evaluation, and there was concordance for presence or absence of RVDCC with catheter angiography in 5 patients (4 negatives for RVDCC, 1 positive). Clinical follow up for the 8 patients that underwent RV decompression had no clinical evidence of myocardial ischemia. Our findings suggest that coronary CTA is reliable as first-line imaging for determination of RVDCC in neonates with PA IVS. These findings, if supported by further prospective study, may reserve invasive coronary angiography for cases with diagnostic uncertainty or at the time of necessary transcatheter interventions.

Keywords: Cardiac CTA; Congenital heart disease; Coronary arteries; Pulmonary atresia intact ventricular septum; Right ventricle dependent coronary circulation.

MeSH terms

  • Cardiac Catheterization
  • Computed Tomography Angiography*
  • Coronary Angiography*
  • Coronary Circulation*
  • Coronary Vessels* / diagnostic imaging
  • Coronary Vessels* / physiopathology
  • Female
  • Heart Defects, Congenital / diagnostic imaging
  • Heart Defects, Congenital / physiopathology
  • Heart Defects, Congenital / surgery
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Predictive Value of Tests*
  • Pulmonary Atresia* / diagnostic imaging
  • Pulmonary Atresia* / physiopathology
  • Pulmonary Atresia* / surgery
  • Reproducibility of Results
  • Retrospective Studies

Supplementary concepts

  • Pulmonary Atresia with Intact Ventricular Septum