Three-Dimensional Rotational Angiography in Children with Single Ventricle Physiology

Abstract

Improvements in surgery and care for children born with single ventricle physiology have increased their survival. This leads to a growing population of patients with this congenital heart defect who often suffer from morbidity requiring reinterventions. Developments in diagnostics and interventions for these patients are therefore crucial and three-dimensional rotational angiography (3DRA) is an example of this. This thesis investigates the additional value of 3DRA in the diagnostic evaluation and percutaneous treatment of children with single ventricle physiology compared to conventional angiography. The results show that 3DRA is of additional value as it provides high spatial resolution, rotatable 3D images of superior diagnostic quality in just one run. Unlike conventional angiography, 3DRA allows the acquired image to be studied from any angle. This provides insight into the complex anatomy and the close interactions between vessels and other surrounding structures in the chest. Such detailed visualization of single ventricle anatomy is essential prior to surgery and percutaneous intervention. In addition, the 3D image can be used as a 'roadmap' to guide percutaneous interventions, resulting in faster, safer and more complex interventions. In addition, 3DRA has taught us in left pulmonary artery stenosis that stent interventions can lead to compression of the left main bronchus, which can be avoided with the development of the oval stent technique with double balloon inflation. Finally, after implementation of a dose reduction protocol, the radiation of 3DRA is reduced limiting the stochastic effects of radiation in these patients.