ARRS 2022 Abstracts

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E1162. Expect the Unexpected! Computed Tomography (CT) Findings in the Post-Operative Adult Congenital Heart Disease (ACHD)
Authors
  1. Mostafa Abozeed; University of Alabama at Birmingham
  2. Asmaa Ahmed; University of Alabama at Birmingham
  3. Muhammad Aziz; University of Alabama at Birmingham
  4. Padma Manapragada; University of Alabama at Birmingham
  5. Satinder Singh; University of Alabama at Birmingham
Background
Due to advances in cardiac surgery, perioperative care, and transcatheter interventions, the majority of infants with congenital heart disease (CHD) now survive and reach adulthood. Due to high spatial and temporal resolution, isotropic imaging fast imaging and wide availability, multidetector CT (MDCT) has emerged as an excellent alternative modality in the evaluation of adult CHD (ACHD).

Educational Goals / Teaching Points
The goals of this exhibit are to know the commonly encountered surgically corrected CHD in adults; know the basic pathophysiology behind each CHD and the most common surgical correction; know the expected post-surgical correction CT findings; and know the unexpected CT findings and complications that could be seen with each surgery.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Post-coarctation repair: 56-year-old man presented to the emergency room with chest discomfort, chest CTA showed aortic coarctation with post-stenotic dilatation and interval post-balloon dilatation and stenting. Post-tetralogy of Fallot (TOF) repair: 19-year-old man with prior history of TOF status after repair followed by pulmonary valve replacement with a homograft; cardiac CTA showed surgical material at the pulmonary homograft, proximal left pulmonary artery stenosis, and post-stenotic dilatation. Post-transposition of the great arteries (TGA) repair : two different patients with prior history of TGA, status post-arterial switch (Jatene’s) procedure; cardiac CTA images showed the LeCompte’s maneuver with the main pulmonary artery (MPA) anterior to the ascending aorta, wheras the central branch pulmonary arteries are draping the aorta. Palliative/univentricular repair (UVR): 28-year-old man with a history of hypo-plastic left heart syndrome, status after Norwood, Glenn, and Fontan procedures; CTA images showed the hypo-plastic left ventricle, Glenn and Fontan shunts, with pre-stenotic aneurysmal dilatation of the inferior vena cava and hypo-plastic ascending aorta. Dilated and tortuous systemic to pulmonary venous collaterals are seen between the right superior pulmonary vein and the azygos vein.

Conclusion
An increasing number of adults with treated and untreated CHD and CT evaluation is becoming common. Many such cases are complicated and require knowledge of anatomy, palliative, and corrective cardiac surgeries, and potential long-term complications. One must always try to get details of any prior surgery and talk to the referring doctors before doing CT. Gated MDCT provides excellent anatomic and cardiac function information. It is extremely useful for structures not well seen on echo such as pulmonary artery and branches, right ventricle function. It is also a reasonable alternative to MRI in patients with metals, incompatible devices, inability to hold breath, claustrophobia, and large patients.