Author: Farhouch Berdjis, M.D.

Dept. of Pediatric Cardiology, St. Joseph Hospital, Orange, CA, USA

Patient History

One-year-old baby girl diagnosed with Tetralogy of Fallot at one month of age. The patient underwent a catheterization with balloon dilation of the pulmonary valve and subsequent angioplasty of the pulmonary arteries. Later, the proximal right and left pulmonary arteries were surgically patched and a complete repair with a ventricular septal defect closure and homograft replacement of the pulmonary valve was performed.

Treatment

Patient was readmitted for elective cardiac catheterization to image her pulmonary arterial tree in its entirety for treatment planning of future interventions. Using a single plane Artis zeego®, the technologist performed a 5-second rotational 3D image of the main pulmonary artery using a 5 french x 80-cm Berman catheter at a rate of 4 ml per second; 2:1 diluted contrast solution. Purpose was to obtain a complete 3D image of the surgically placed homograft valve and the right and left pulmonary arteries.

Clinical Impressions

The pulmonary artery tree, selective injections in the main, right, and left pulmonary arteries are traditionally necessary. This requires at least three, and perhaps up to five, separate angiograms each using 1 cc contrast/ kg. The 3D angiography required 2 cc per kg with far less dose for the patient.

“In addition, even with multiple angios, you cannot obtain the same comfort level and understanding of the complex pulmonary artery anatomy. The 3D angio demonstrated the locations and extent of the stenoses in detail. Rotating the image on the screen and then correlating the flat detector angle results in a accurate road map on the screen; it cannot be duplicated with traditional biplane angiography.”

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