Three-Dimensional Rotational Angiography to Guide Cardiac Catheterization in Critical Infants Below 5kg of Body Weight

Abstract

Background: Three-dimensional rotational angiography (3DRA) is a promising advancement to guide cardiac catheterizations. It is used with restraint in critically ill infants with congenital heart disease (CHD) due to the lack of research conducted within this patient group. Methods: Data of all infants with CHD and a body weight <5 kg who underwent cardiac catheterization with the use of 3DRA between November 2011 and April 2021 were retrospectively analyzed. Primary outcome measures were 3DRA-related periprocedural deaths or major adverse events (MAEs). Secondary outcome measures were 3DRA-related minor adverse events (MiAEs), the amount of radiation exposure and contrast agent, and whether 3DRA led to important new findings. The case-based workflow of 3DRA in vulnerable infants is explained. Results: Eighty-six patients underwent 109 cardiac catheterizations in which 132 3DRA scans were performed. Median age and weight were 50.0 days (IQR, 20.0-98.5) and 3.8 kg (IQR, 3.2-4.5). There were no periprocedural deaths or MiAEs, and only 2 MAEs occurred, both concerning ventricular fibrillation. The median radiation exposure was 160.0 cGy⋅cm2 (IQR, 81.3-257.5), of which 28.0 cGy⋅cm2 (IQR, 19.4-43.0) was derived from 3DRA. The mean amount of contrast agent used was 4.8 ± 1.6 mL/kg. In 70.6%, 3DRA imaging led to important new findings. Multivariate binary logistic regression analysis showed the presence of comorbidity to be associated with a lower odds of receiving a 3DRA-derived radiation dose ≥15 cGy⋅cm2 (P =.01). Additionally, the interval between surgery and cardiac catheterization was significantly associated with higher odds of a contrast dye consumption ≥6 mL/kg (P =.046). Conclusions: 3DRA proved to be safe in vulnerable infants with CHD weighing <5 kg, enabling visualization of anatomical substrates often invisible in conventional angiography. However, when an advanced computed tomography scanner is available, the diagnostic purposes for 3DRA are few. The greatest benefit of 3DRA usage is interventional guidance (3D roadmap).