Four-Dimensional Dynamic Volume Cardiac Angiography With 320-detector Computed Tomography: Assessment Of Atrial Septal Defect

Part one Four-Dimensional Dynamic Volume Cardiac Angiography with 320-Detector Computed Tomography :Assessment of Atrial Septal Defect with Percutaneous Transcatheter ClosureObjective To evaluate the clinic application of four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography in assessment of atrial septal defect(ASD)with percutaneous transcatheter closure.Materials and Methods Eighteen patients with secundum ASD who underwent successfully percutaneous transcatheter closure or surgery treatment were enrolled(12males and 6 females;mean age,30.6 years,range,7-53years).all patients underwent two-dimensional transthoracic echocardiography(2D-TTE)and four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography to determine the size,rim tissue,total septal diameter,direction of shunt flow and extracardial vascular malformation.Based on 2D-TTE findings,suitable size of the atrial septal occluder(ASO)was selected and used,under 2D-TEE guidance the occlude was accurately placed.Using postoperative occluder-waist size(POS)as the reference standard,four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography in assessment ASD size,rim tissue,and other extracardial vascular malformation were compared with 2D-TTE.Results Fifteen patients successfully underwent percutaneous transcatheter closure,and three patients underwent surgical treatment.In surgical treatment group(n=3),two cases of superior sinus venosus ASD with partial anomalous pulmonary venous drainage(PAPVD)and one case of inferior sinus venosus ASD were diagnosis with four-dimensional dynamic cardiac angiography and missed diagnosis or not clear by2D-TTE.In percutaneous transcatheter closure group(n=15),there were no significant differences in ASD maximum diameter,minimum diameter measured by four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography and 2D-TTE(p > 0.05),and showed good correlation(r=0.93,0.89,p <0.001).ASD maximum diameter,minimum diameter measured by four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography were slightly higher than that measured by 2D-TTE.Compared with 2D-TTE,the maximum diameter of ASD measured by four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography is closer to the reference standard POS and AOS,and the correlations were better(r=0.96,0.96,p<0.001).The anterior inferior,anterior superior,posterior inferior,posterior superior and posterior rims could be evaluated in all patients with four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography,2D-TTE was difficult to detect rim tissue,especially in posterior inferior rim.there was no significant difference in ASD total septal diameter measured by four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography and 2D-TTE(p > 0.05),and showed good correlation(r=0.78,p < 0.001).four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography can clearly show the direction of the interatrial shunt,13 cases of left to right shunt,and 2 cases of bidirectional shunt.Conclusion Four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography can accurately evaluate the ASD size,rim tissue,total septal diameter,direction of interatrial shunt and can also evaluate extracardial vascular disease or malformation,and is helpful for assessment of ASD patients before percutaneous transcatheter closure.Part two Four-Dimensional Dynamic Volume Cardiac Angiography with 320-Detector Computed Tomography :Assessment of Left Ventricular Function in Patients with ASDObjective To evaluate the feasibility and accuracy of left ventricular(LV)function measured by Four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography in patients with ASD by comparing the correlation and concordance with two-dimensional Transthoracic echocardiography(2D-TTE).Materials and Methods 15 patients(11 males and 4 females;mean age,32.1 years;range,7-53 years)of atrial septal defect were included in the study,all patients underwent clinical,ECG,chest X-ray and 2D-TTE,then diagnosis with secundum ASD.All patients were underwent Four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography using CTA/CFA volume scan mode with retrospective ECG gated,the reconstruction image were loaded in workstation,LV function parameters were analysed and calculated,including LV end-diastolic volume(EDV),end-systolic volume(ESV),stroke volume(SV),ejection fraction(EF).These LV function parameters were compared with 2D-TTE,using as the reference standard.Result There were no significant differences in EDV,ESV,SV,EF between Four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography and 2D-TTE(p>0.05),and showed good correlations(r=0.93、0.94、0.91、0.81,all p < 0.001).LV function parameters(ESV,SV,EF)measured by Four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography were higher than that measured by 2D-TTE and ESV measured by Four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography were slightly lower than that measured by 2D-TTE.Conclusion1.Four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography non-invasive "one-stop" examination in ASD patients can evaluate the cardiac and extracardial vascular disease or malformation and can evaluate LV function simultaneously,can provide more information for clinical diagnosis.2.Four-dimensional dynamic volume cardiac angiography with 320-detector computed tomography evaluation of LV function in patients with ASD showed a good correlation with 2D-TTE,can accurate assessment of LV function in patients with ASD.