Evaluation of pulmonary arteries and source of pulmonary blood supply in children with pulmonary atresia and ventricular septal defect using CT angiography
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Abstract
Objective: To evaluate pulmonary arteries and determine the sources of pulmonary blood supply in children with pulmonary atresia and ventricular septal defect (PA-VSD) using computed tomography angiography (CTA).
Methods: This retrospective cross-sectional study was conducted at Pediatric Cardiology Clinic, Hayatabad Medical Complex, Peshawar, Pakistan, from January 2009 to December 2019. Pediatric patients (≤18 years) with confirmed PA-VSD who underwent CTA for preoperative anatomical assessment were included. CTA was used to evaluate pulmonary artery morphology, patent ductus arteriosus (PDA), and major aortopulmonary collateral arteries (MAPCAs). Based on CTA findings, patients were classified according to the source of pulmonary blood supply into Type A (native pulmonary arteries supplied via PDA), Type B (native pulmonary arteries supplied by both PDA and MAPCAs), and Type C (absence of native pulmonary arteries with MAPCAs only). Statistical analysis was performed using SPSS version-22.
Results: Ninety-one patients were included, with a mean age of 3.2±2.8 years; 58 (63.7%) were males. Cyanosis was the most common presenting symptom (94.5%). Type B PA-VSD was the most frequent anatomical pattern (46.2%), followed by Type C (27.5%) and Type A (26.4%). Twenty-four patients (26.4%) had oxygen saturations below 60%, 50 patients (54.9%) had oxygen saturations between 60% and 80%, and 17 patients (18.7%) had oxygen saturations above 80% (p=0.018). CTA demonstrated higher detection rates than echocardiography for MAPCAs (83.3% vs 47.4%, p<0.001) and pulmonary artery stenosis (25.6% vs 10.3%, p=0.012).
Conclusion: CTA provides comprehensive anatomical delineation of pulmonary arteries and collateral circulation in PA-VSD and is valuable for accurate preoperative evaluation.
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