Assessment of systemic-pulmonary collateral arteries in children with cyanotic congenital heart disease using multidetector-row computed tomography: comparison with conventional angiography.

BACKGROUND: The present study aimed to assess the feasibility of multidetector-row computed tomography (MDCT) for the evaluation of systemic-pulmonary collateral (SPC) arteries in children with congenital heart disease associated with reduced pulmonary blood flow. METHODS: Forty-eight consecutive patients (mean age 9+/-5 months; range, 0-30 months) underwent MDCT angiography of the thorax with a 16-detector row scanner prior to cardiac catheterization and operation. Conventional angiographic findings were used as a gold standard for the detection of SPC vessels. Findings on CT angiograms, including CT scans, maximum intensity projections, and three-dimensional volume-rendered images, were used to evaluate depiction of SPC arteries. Quantification of measurements at the SPC artery diameter was evaluated independently on MDCT and conventional invasive angiography. RESULTS: Among the 48 patients, 115 SPC arteries were identified with conventional angiography, and 94 SPC arteries were identified with MDCT. In 89 (77%) vessels, concordant findings were observed with both modalities, with adequate depiction in 53 vessels and suboptimal depiction in 36 vessels. In 26 (23%) vessels, MDCT was unable to identify SPC arteries. Further, CT angiography resulted in the false-positive identification of vessels in 5 cases. There was an excellent correlation between MDCT- and conventional angiography-based measurement of SPC vessel diameter (R(2)=0.83), although a systematic overestimation was observed with MDCT (bias 0.19+/-0.74 mm). CONCLUSIONS: This study demonstrates that MDCT is a potentially useful tool, which may have implications for planning percutaneous interventions and surgical repair in the future.

Device occlusion of Fontan fenestration--an economical alternative.

Fenestrating the Fontan circuit during total cavopulmonary anastomosis is commonly performed to reduce postoperative mortality and morbidity. The resulting systemic desaturation may progressively increase leading to symptoms. We report the case of a symptomatic eight year old, whose Fontan circuit fenestration was closed using a patent ductus arteriosus occluder. The marked improvement in the patient's clinical status immediately and after 3 months confirms this device to be a safe, and economically better alternative to the atrial septal defect occluder.

[Assessment of the reasons prompting a first echocardiography in children: a Lebanese multicenter study]. / Motifs de demande d'une première echocardiographie en pédiatrie: expérience multicentrique Libanaise.

OBJECTIVES: To study the different indications behind performance of a first Doppler echocardiography (DE) in children, to assess the results and their impact on the residency teaching program in Lebanon. MATERIAL AND METHODS: Retrospective study over a 40-month period, from March 1st, 2002, through June 30, 2005. Patients referred for the first DE were examined in different medical centers in Beirut, Mount-Lebanon and South Lebanon. RESULTS: 3137 new patients aged from 0 to 18 years (average: 54 months) were included in the analysis. The percentage of patients seen as outpatients was 48% ; in departments of pediatrics and emergency rooms: 38.2%; intensive care neonatal units: 13%; and in maternity wards/nurseries: 0.8%. 2198 patients (70.1%) had normal DE. Heart murmur accounts for 45.6% of DE requests, followed by extracardiac malformations and presence of dysmorphic features (7.2%), cyanosis (6.8%), suspicion of rheumatic fever (5.7%), cardiac arrhythmia (3.8%), bronchopneumopathies and respiratory distress (3.5%), chest pain and palpitations (3.3%). Innocent murmur was found in 53.9% of patients referred for heart murmur; among syndromes and malformations, Down's syndrome was the most frequent pathology, followed by polymalformations, the VACTERL syndrome and the cleft lip and palate. Cyanotic congenital heart disease was diagnosed in 34% of cases referred for cyanosis. The diagnosis of carditis was confirmed in 84.6% of children with clinical picture of rheumatic fever. In cases of malaise, dizziness and loss of consciousness, no abnormality was detected on DE. CONCLUSION: DE should be a complement to clinical exam, which is often sufficient to reveal a cardiac pathology. However, some conditions, where cardiovascular exam is normal require a DE. The question of when and why to request a DE must be a priority in the pediatric resident training program.