RESUMO
BACKGROUND: The adult practice for ECG-gated single-source 64-slice coronary CTA (CCTA) includes administering beta-blockers to reduce heart rate. There are limited data on this process in children. OBJECTIVE: To evaluate the safety and efficacy of a drug regimen to decrease heart rate before performing CCTA in children. MATERIALS & METHODS: IV remifentanil and esmolol infusion were chosen to decrease heart rate in 41 children (mean age 6.5 years) while they were under general anesthesia (GA) for CCTA. Drug doses, changes in heart rate and procedural complications were recorded. CCTA image quality was graded on a scale of 1 to 5. The relationships between image quality and heart rate and image quality and age were evaluated. Patient effective radiation doses were calculated. RESULTS: Heart rates were lowered utilizing esmolol (4 children), remifentanil (2 children) or both (35 children); 26 children received nitroglycerin for coronary vasodilation. The mean decrease in heart rate was 26%. There were no major complications. The average image-quality score was 4.4. Higher heart rates were associated with worse image quality (r = 0.67, P < 0.0001). Older age was associated with better image quality (r = 0.66, P < 0.0001). Effective radiation doses were 0.7 to 7.0 mSv. CONCLUSION: Heart rate reduction for pediatric CCTA can be safely and effectively achieved while yielding high-quality images.
Assuntos
Antagonistas Adrenérgicos beta , Técnicas de Imagem de Sincronização Cardíaca/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Eletrocardiografia/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/efeitos adversos , Criança , Pré-Escolar , Angiografia Coronária/efeitos dos fármacos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: Our objective is to discuss neonatal spine sonography with emphasis on imaging pitfalls and normal variants that may simulate disease and to distinguish them from true spinal disorders. CONCLUSION: Sonography of the neonatal spine is now accepted as a highly sensitive, readily available screening study that can be used to evaluate various anomalies of the lumbar spine in most infants younger than 4 months.
Assuntos
Artefatos , Aumento da Imagem/métodos , Vértebras Lombares/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Ultrassonografia/métodos , Humanos , Recém-Nascido , Guias de Prática Clínica como Assunto , Padrões de Prática MédicaRESUMO
OBJECTIVE: The objective of part 2 of this article is to focus on key imaging features of common skin-covered spinal anomalies (spina bifida occulta) and to distinguish them from normal variants (previously discussed in part 1). CONCLUSION: Modern imaging technology allows accurate neonatal spinal sonographic screening and the characterization of spinal abnormalities within the first few days of life. It is useful to determine the type of lesion present and to guide the type and timing of therapy.