CTA for 100 Days Infant with Single Ventricle Defect


Introduction

Single Ventricle Defect

Diagnosis of Single Ventricle Anomalies

  1. Echocardiogram
  2. CT Angiogram
  3. Cardiac Catheterization

Patient’s History and Information

uSex  –    Female

uAge  –    100 Days

uBody Weight  –    4.5 kg

uHIV Ab / HBs Ag/ HCV Ab  –    Non Reactive

uCreatinine  –    0.4 mg/dl

ueGFR  –    158 ml/min/1.73 m2

uCXR  –    Cardio-thoracic Ratio (7:11) noted

uEchocardiography  –    Large VSD, ASD, DORV with side by side great   vessels with small PDA

Preparation before scanning

Informed Consent and Contraindication;

u22G IV Access

uBlood pressure monitor

uO2 sat monitor

uEKG Leads

uWall Outlet Oxygen Supply

Emergency First-Aid Kit

Preparation before scanning

uNormal saline 100CC (Drip Line)

uAfter 15-min,

Melatonin 3-6 mg , Diazepam 0.3 mg/kg/dose (Administered by Emergency Medical Specialist & Pediatrician)

Materials and Methods

TOSHIBA Aquilion Prime 160 slice CT Scanner

-Low Dose CTA (Gated) Pediatric Protocol

-Contrast ————–            Pamiray 370mg ( Iopamidol 0.7552g per ml)

-Rate for contrast—-              1.8ml/s …. 8ml

1.8ml/s …..5ml

-Rate for normal saline—-   1.8ml/s……7ml

-ROI ———————–      Right Ventricle (Manual triggering)

Low Dose CTA Protocol

vLow Dose CTA mode is a low-dose scanning technique in which exposure is performed for a portion of the R-R interval(generally diastole).

vThe desired exposure phase is set as a percentage of the R-R interval, so the actual exposure time varied depending on the patient’s heart rate.

vThe exposure phase setting can be expanded to include systole if the heart rate is high, and a function is provided to perform such setting based on the results of breathing exercise.

vMultisegmental reconstruction is also available for patients with high heart rates.

Biphasic Injection with Contrast/Saline Mix

A biphasic injection protocol with contrast/saline mix reduces streak artifact in the SVC and right heart, but maintains adequate opacification of the right ventricle.

This may improve the detection of the ventricular septal wall.

Scanning Protocol & Techniques

Scanning Protocol & Techniques

Scanning Protocol & Techniques

Scanning Protocol & Techniques

Scanning Protocol & Techniques

Imaging

   

After care for the patient

  • Normal saline 100CC (Drip line)
  • Under cared by Emergency Medical Team and Pediatrician
  • Checked BP & SPO2 and check the patient’s situation 1 hr.   after the exam.

Reference

  • http://xray.ufl.edu/files/2008/06/CT-Guidelines   for-Creatinine-Levels.pdf
  • Cleveland Clinic Guidelines(as of January 2009)
  • Helen B. Taussig Children’s Heart Centre  John Hopkins University
  • American Academy of pediatrics and American Academy of Pediatric Dentistry. Guideline for monitoring and management of pediatric patients during and after sedation for diagnostic therapeutic procedure 2011.
  • Lucilc Packard Children’s Hospital, Stanford University Medical Centre. Pediatric anasthesis and pain management

 

General Enquiries

  • 95-1-657227
  • No.(60)(G-1),New Parami Road,Mayangone Township,Yangon,Myanmar.
  • info@Paramihospital.com

CME Events

April
10
Friday
Date 10 Apr Friday
Time 1:00 PM - 2:00 PM
Venue Seminar Room Level 2

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