Multi-institution assessment of the use and risk of cardiovascular computed tomography in pediatric patients with congenital heart disease

• Published in: Journal of cardiovascular computed tomography Vol. 15; no. 5; pp. 441 - 448
• Main Authors: De Oliveira Nunes, Mariana, Witt, Dawn R., Casey, Susan A., Rigsby, Cynthia K., Hlavacek, Anthony M., Chowdhury, Shahryar M., Nicol, Edward D., Semple, Thomas, Lesser, John R., Storey, Katelyn M., Kunz, Miranda S., Schmidt, Christian W., Stanberry, Larissa I., Han, B. Kelly
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2021
• Subjects: Cardiac computed tomography; Child; Child, Preschool; Comprehensive diagnostic risk; Congenital heart disease; Coronary Angiography - adverse effects; Dose length product; Heart Defects, Congenital - diagnostic imaging; Humans; Infant; Pediatric; Predictive Value of Tests; Radiation Dosage; Tomography, X-Ray Computed; Cardiac computed tomography; Congenital heart disease; Comprehensive diagnostic risk; Pediatric; Dose length product
• ISSN: 1934-5925; 1876-861X
• DOI: 10.1016/j.jcct.2021.01.003

Cardiac computed tomography (CT) is increasingly used in pediatric patients with congenital heart disease (CHD). Variability of practice and of comprehensive diagnostic risk across institutions is not known.
Four centers prospectively enrolled consecutive pediatric CHD patients <18 years of age undergoing cardiac CT from January 6, 2017 to 1/30/2020. Patient characteristics, cardiac CT data and comprehensive diagnostic risk were compared by age and institutions. Risk categories included sedation and anesthesia use, vascular access, contrast exposure, cardiovascular medication, adverse events (AEs), and estimated radiation dose.
Cardiac CT was performed in 1045 pediatric patients at a median (interquartile range, IQR) age of 1.7 years (0.3, 11.0). The most common indications were arterial abnormalities, suspected coronary artery anomalies, functionally single ventricle heart disease, and tetralogy of Fallot/pulmonary atresia. Sedation was used in 8% and anesthesia in 11% of patients. Peripheral vascular access was utilized for 93%. Median contrast volume was 2 ​ml/kg. Beta blockers were administered in 11% of cases and nitroglycerin in 2% of cases. The median (IQR) total procedural dose length product (DLP) was 20 ​mGy∗cm (10, 50). Sedation, vascular access, contrast exposure, use of cardiovascular medications and radiation dose estimates varied significantly by institution and age (p ​< ​0.001). Seven minor adverse events (0.7%) and no major adverse events were reported.
Cardiac CT for CHD is safe in pediatric patients when appropriate CT technology and expertise are available. Scans can be acquired at relatively low radiation exposure with few minor adverse events.
We conducted a prospective multi-institutional evaluation of variability of practice and comprehensive diagnostic risk for cardiac CT in pediatric CHD patients. 1329 scans were performed in 1045 patients at four institutions from January 6, 2017 to 1/30/2020 in patients from 1 day to <18 years of age. Anesthesia and sedation were required in a minority of cases, with a very low rate of adverse events and low radiation exposure (median procedural DLP 20 ​mGy∗cm). However, variation exists between institutions, warranting future exploration and quality improvement initiatives to develop best practice guidelines and reduced practice variability.