Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Computed Tomography-Based Ventricular Volumes and Morphometric Parameters for Deciding the Treatment Strategy in Children with a Hypoplastic Left Ventricle: Preliminary Results

  • Goo, Hyun Woo (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Park, Sang-Hyub (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
  • Received : 2018.03.27
  • Accepted : 2018.07.02
  • Published : 2018.12.01
⟨ Previous Next ⟩

Abstract

Objective: To determine the utility of computed tomography (CT) ventricular volumes and morphometric parameters for deciding the treatment strategy in children with a hypoplastic left ventricle (LV). Materials and Methods: Ninety-four consecutive children were included in this study and divided into small LV single ventricle repair (SVR) (n = 28), small LV biventricular repair (BVR) (n = 6), disease-matched control (n = 19), and control (n = 41) groups. The CT-based indexed LV volumes, LV-to-right-ventricular (LV/RV) volume ratio, left-to-right atrioventricular valve (AVV) area ratio, left-to-right AVV diameter ratio, and LV/RV long dimension ratio were compared between groups. Proportions of preferred SVR in the small LV SVR group suggested by the parameters were evaluated. Results: Indexed LV end-systolic (ES) and end-diastolic (ED) volumes in the small LV SVR group ($6.3{\pm}4.0mL/m^2$ and $14.4{\pm}10.2mL/m^2$, respectively) were significantly smaller than those in the disease-matched control group ($16.0{\pm}4.7mL/m^2$ and $37.7{\pm}12.0mL/m^2$, respectively; p < 0.001) and the control group ($16.0{\pm}5.5mL/m^2$ and $46.3{\pm}10.8mL/m^2$, respectively; p < 0.001). These volumes were $8.3{\pm}2.4mL/m^2$ and $21.4{\pm}5.3mL/m^2$, respectively, in the small LV BVR group. ES and ED indexed LV volumes of < $7mL/m^2$ and < $17mL/m^2$, LV/RV volume ratios of < 0.22 and < 0.25, AVV area ratios of < 0.33 and < 0.24, and AVV diameter ratios of < 0.52 and < 0.46, respectively, enabled the differentiation of a subset of patients in the small LV SVR group from those in the two control groups. One patient in the small LV biventricular group died after BVR, indicating that this patient might not have been a good candidate based on the suggested cut-off values. Conclusion: CT-based ventricular volumes and morphometric parameters can suggest cut-off values for SVR in children with a hypoplastic LV.

Keywords

References

  1. van Son JA, Phoon CK, Silverman NH, Haas GS. Predicting feasibility of biventricular repair of right-dominant unbalanced atrioventricular canal. Ann Thorac Surg 1997;63:1657-1663 https://doi.org/10.1016/S0003-4975(97)00230-0
  2. Tuo G, Khambadkone S, Tann O, Kostolny M, Derrick G, Tsang V, et al. Obstructive left heart disease in neonates with a “borderline” left ventricle: diagnostic challenges to choosing the best outcome. Pediatr Cardiol 2013;34:1567-1576 https://doi.org/10.1007/s00246-013-0685-5
  3. Overman DM, Dummer KB, Moga FX, Gremmels DB. Unbalanced atrioventricular septal defect: defining the limits of biventricular repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2013;16:32-36 https://doi.org/10.1053/j.pcsu.2013.01.009
  4. Kaplinski M, Cohen MS. Characterising adequacy or inadequacy of the borderline left ventricle: what tools can we use? Cardiol Young 2015;25:1482-1488 https://doi.org/10.1017/S1047951115002267
  5. Grosse-Wortmann L, Yun TJ, Al-Radi O, Kim S, Nii M, Lee KJ, et al. Borderline hypoplasia of the left ventricle in neonates: insights for decision-making from functional assessment with magnetic resonance imaging. J Thorac Cardiovasc Surg 2008;136:1429-1436 https://doi.org/10.1016/j.jtcvs.2008.04.027
  6. Kim HJ, Goo HW, Park SH, Yun TJ. Left ventricle volume measured by cardiac CT in an infant with a small left ventricle: a new and accurate method in determining uni- or biventricular repair. Pediatr Radiol 2013;43:243-246 https://doi.org/10.1007/s00247-012-2464-5
  7. Goo HW. Serial changes in anatomy and ventricular function on dual-source cardiac computed tomography after the Norwood procedure for hypoplastic left heart syndrome. Pediatr Radiol 2017;47:1776-1786 https://doi.org/10.1007/s00247-017-3972-0
  8. Goo HW. Cardiac MDCT in children: CT technology overview and interpretation. Radiol Clin North Am 2011;49:997-1010 https://doi.org/10.1016/j.rcl.2011.06.001
  9. Goo HW, Allmendinger T. Combined electrocardiography- and respiratory-triggered CT of the lung to reduce respiratory misregistration artifacts between imaging slabs in freebreathing children: initial experience. Korean J Radiol 2017;18:860-866 https://doi.org/10.3348/kjr.2017.18.5.860
  10. Goo HW. Individualized volume CT dose index determined by cross-sectional area and mean density of the body to achieve uniform image noise of contrast-enhanced pediatric chest CT obtained at variable kV levels and with combined tube current modulation. Pediatr Radiol 2011;41:839-847 https://doi.org/10.1007/s00247-011-2121-4
  11. Deak PD, Smal Y, Kalender WA. Multisection CT protocols: sex- and age-specific conversion factors used to determine effective dose from dose-length product. Radiology 2010;257:158-166 https://doi.org/10.1148/radiol.10100047
  12. Goo HW. CT radiation dose optimization and estimation: an update for radiologists. Korean J Radiol 2012;13:1-11 https://doi.org/10.3348/kjr.2012.13.1.1
  13. Goo HW, Park SH. Semiautomatic three-dimensional CT ventricular volumetry in patients with congenital heart disease: agreement between two methods with different user interaction. Int J Cardiovasc Imaging 2015;31 Suppl 2:223-232 https://doi.org/10.1007/s10554-015-0751-6
  14. Cohen MS, Jacobs ML, Weinberg PM, Rychik J. Morphometric analysis of unbalanced common atrioventricular canal using two-dimensional echocardiography. J Am Coll Cardiol 1996;28:1017-1023 https://doi.org/10.1016/S0735-1097(96)00262-8
  15. Jegatheeswaran A, Pizarro C, Caldarone CA, Cohen MS, Baffa JM, Gremmels DB, et al. Echocardiographic definition and surgical decision-making in unbalanced atrioventricular septal defect: a Congenital Heart Surgeons' Society multiinstitutional study. Circulation 2010;122(11 Suppl):S209-S215 https://doi.org/10.1161/CIRCULATIONAHA.109.925636
  16. Lugones I, Biancolini MF, Biancolini JC, Dios AMS, Lugones G. Feasibility of biventricular repair in right dominant unbalanced atrioventricular septal defect: a new echocardiographic metric to refine surgical decision-making. World J Pediatr Congenit Heart Surg 2017;8:460-467 https://doi.org/10.1177/2150135117716420
  17. Leung MP, McKay R, Smith A, Anderson RH, Arnold R. Critical aortic stenosis in early infancy. Anatomic and echocardiographic substrates of successful open valvotomy. J Thorac Cardiovasc Surg 1991;101:526-535
  18. Goo HW. Current trends in cardiac CT in children. Acta Radiol 2013;54:1055-1062 https://doi.org/10.1258/ar.2012.120452
  19. Mahle WT, Weinberg PM, Rychik J. Can echocardiography predict the presence or absence of endocardial fibroelastosis in infants < 1 year of age with left ventricular outflow obstruction? Am J Cardiol 1998;82:122-124 https://doi.org/10.1016/S0002-9149(98)00243-4
  20. Stranzinger E, Ensing GJ, Hernandez RJ. MR findings of endocardial fibroelastosis in children. Pediatr Radiol 2008;38:292-296 https://doi.org/10.1007/s00247-007-0707-7
  21. Goo HW. Myocardial delayed-enhancement CT: initial experience in children and young adults. Pediatr Radiol 2017;47:1452-1462 https://doi.org/10.1007/s00247-017-3889-7
  22. Rhodes LA, Colan SD, Perry SB, Jonas RA, Sanders SP. Predictors of survival in neonates with critical aortic stenosis. Circulation 1991;84:2325-2335 https://doi.org/10.1161/01.CIR.84.6.2325
  23. Lofland GK, McCrindle BW, Williams WG, Blackstone EH, Tchervenkov CI, Sittiwangkul R, et al. Critical aortic stenosis in the neonate: a multi-institutional study of management, outcomes, and risk factors. Congenital Heart Surgeons Society. J Thorac Cardiovasc Surg 2001;121:10-27 https://doi.org/10.1067/mtc.2001.111207
  24. Colan SD, McElhinney DB, Crawford EC, Keane JF, Lock JE. Validation and re-evaluation of a discriminant model predicting anatomic suitability for biventricular repair in neonates with aortic stenosis. J Am Coll Cardiol 2006;47:1858-1865 https://doi.org/10.1016/j.jacc.2006.02.020

Cited by

  1. Changes in Right Ventricular Volume, Volume Load, and Function Measured with Cardiac Computed Tomography over the Entire Time Course of Tetralogy of Fallot vol.20, pp.6, 2018, https://doi.org/10.3348/kjr.2018.0891
  2. Volumetric Severity Assessment of Ebstein Anomaly Using Three-Dimensional Cardiac CT: A Feasibility Study vol.3, pp.3, 2018, https://doi.org/10.22468/cvia.2019.00052
  3. Quantification of Initial Right Ventricular Dimensions by Computed Tomography in Infants with Congenital Heart Disease and a Hypoplastic Right Ventricle vol.21, pp.2, 2018, https://doi.org/10.3348/kjr.2019.0662
  4. Pattern Analysis of Left Ventricular Remodeling Using Cardiac Computed Tomography in Children with Congenital Heart Disease: Preliminary Results vol.21, pp.6, 2020, https://doi.org/10.3348/kjr.2019.0689
  5. Characteristics of Recent Articles Published in the Korean Journal of Radiology Based on the Citation Frequency vol.21, pp.12, 2020, https://doi.org/10.3348/kjr.2020.1322
  6. Double Outlet Right Ventricle: In-Depth Anatomic Review Using Three-Dimensional Cardiac CT Data vol.22, pp.None, 2018, https://doi.org/10.3348/kjr.2021.0248
  7. Unbalanced atrioventricular septal defect with dominant right ventricle: diagnostic criteria, indications for biventricular correction, and results. A clinical observation series vol.49, pp.5, 2021, https://doi.org/10.18786/2072-0505-2021-49-057