Invited Commentary:
The use of alternative additional imaging in the diagnosis and surgical
treatment planning of congenital heart and adult congenital heart
continues to illustrate the limitations of current therapy and may
greatly aid the survival of these patients. In this study, Vasquez Choy
et al. performed a retrospective chart review examining limitations of
echocardiography with additional imaging of Computed Tomography (CT) in
patients with a diagnosis of Single Ventricle (SV) and Total Anomalous
Pulmonary Venous Connection (TAPVC). The time period studied is recent,
from 2016 until 2021, and is a small sample size of 13 patients.
However, the patients represent a difficult challenge of single
ventricle functional diagnosis and the additional diagnosis of TAPVC.
Most (8/13) patients in this study had a primary diagnosis of unbalanced
atrioventricular septal defect (AVSD) with pulmonary atresia (n=6) or
arch obstruction (n=2).
While most congenital intra-cardiac diagnosis can successfully be
determined, pediatric echocardiography may have limitations to diagnose
extra-cardiac pulmonary venous confluence abnormalities. In this study,
the authors noted that utilizing echocardiography gave a complete
anatomic diagnosis in 1 of 13 patients, while the CT gave 13/13 cases
complete anatomic diagnosis. Historically, the use of diagnostic
angiography has been performed. The authors highlight the difficulty of
diagnostic angiography and note their institution’s transition to CT.
The authors do not however suggest an either/or comparison rather a
benefit to AAI.
How soon can imaging studies, obtained from CT, be constructed into 3D
models, virtual reality, or other modalities to aid in surgical
correction or catheter based intervention? This study will aid the
reader to note additional imaging complementary to echocardiography. The
patients examined in the time group are noted to have 4 deaths, all
related to challenges associated with single ventricle physiology such
as extra cardiac complications (gastrointestinal bleeding, septic shock,
and progression of neurological congenital abnormalities). The next
challenge in consideration of MRI compared to diagnostic catheterization
for stage II palliation and complementary examinations may serve as a
manuscript many readers will be eager to see in follow up. The authors
note the survival of 9 of 13 patients alive at the end of data
collection, long term, will have most readers cheering for successful
completion to stage III palliation and success for this difficult and
complex group of TAPVC and single ventricle patients.