Intravenous digital subtraction angiography in the assessment of patients with left to right shunts before and after surgical correction

• Published in: Journal of the American College of Cardiology 1984-06, Vol.3 (6), p.1507-1514
• Main Authors: Yiannikas, John, Moodie, Douglas S., Gill, Carl C., Sterba, Richard, McIntyre, Ray, Buonocore, Edward
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Angiography - methods; Biological and medical sciences; Cardiac Catheterization; Cardiology. Vascular system; Child; Child, Preschool; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Female; Heart; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - surgery; Humans; Infant; Male; Medical sciences; Middle Aged; Pulmonary Artery - diagnostic imaging; Radionuclide Imaging; Subtraction Technique; Technetium
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(84)80290-9

Pre- and postoperative structural changes and pulmonary to systemic flow (QP/QS) ratios were assessed using digital angiography in 34 patients documented to have a left to right shunt at cardiac catheterization. There were 16 men and 18 women whose ages ranged from 4 months to 60 years. The radiographic single mask mode was used for all digital subtraction angiographic studies with a typical radiographic sequence being 80 to 100 kV, 5 to 10 mA/frame at six frames/s for 15 seconds. Renografin-76 was used as a bolus injection at 0.5 to 1.0 ml/kg via an arm vein in most patients. The level of the left to right shunt and any associated anomalies were noted and compared with results from cardiac catheterization. Digital subtraction angiographic flow curves were generated from the pulmonary arteries, and QP/QS ratios were calculated pre- and postoperatively using the gamma variate fit method and compared with the QP/QS ratio from first pass radionuclide studies. A strong correlation between preoperative digital subtraction angiographically derived QP/QS ratio and radionuclide-derived QP/QS ratio was found, with an r value equal to 0.89, p < 0.0001. Postoperatively, all patients had a QP/QS ratio less than 1.2:1.0 for both digital subtraction angiography and radionuclide studies. The level of left to right shunt was accurately assessed in all patients, and its absence observed postoperatively. Associated anomalies, such as a persistent left superior vena cava, coarctation of the aorta and partial anomalous venous return, were identified in all cases. Intravenous digital subtraction angiography provides accurate quantitative and anatomic data in patients with a left to right shunt, is potentially an important outpatient method to assess adequate surgical correction and may suffice preoperatively to proceed to cardiac surgery without preoperative cardiac catheterization.