Ann Thorac Surg 2008;86:e4. doi:10.1016/j.athoracsur.2008.08.040
© 2008 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Cardiovascular Dual Source Computed Tomography for Aortic Coarctation in a Neonate: One-Second Scan With Ultra-Low Radiation Dose
Gorka Bastarrika, MDa,
Carlo Nicola De Cecco, MDd,*,
Patricia Bastero, MDb,
Maria Arraiza, MDa,
Joaquín Barba, MDc,
Amedeo Anselmi, MDe,
Valentin Alzina, MDb
a Department of Radiology, Clínica Universitaria, Universidad de Navarra, Pamplona, Spain
b Department of Pediatrics, Clínica Universitaria, Universidad de Navarra, Pamplona, Spain
c Department of Cardiology, Clínica Universitaria, Universidad de Navarra, Pamplona, Spain
d Department of Radiological Sciences, Università di Roma "La Sapienza"–Ospedale Sant' Andrea, Rome, Italy
e Division of Cardiac Surgery, Catholic University, Rome, Italy
* Address correspondence to Dr De Cecco, Department of Radiology, University of Rome "Sapienza," Via di Grottarossa 1035, Rome, 00186, Italy (Email: carlodececco{at}gmail.com).
A 17-day-old neonate was referred for cardiovascular computed tomographic scan to rule out a possible aortic coarctation. Previous transthoracic echocardiography revealed partial atrioventricular canal defect with enlarged and hypertrophic right ventricle, right atrial dilatation, and normal left chambers. The evaluation of the aorta did not reveal any significant abnormality, except a possible hypoplastic aortic arch. No flow acceleration or other signs indicating aortic coarctation were noted after the Doppler examination. Ultra low-dose dual-source computed tomographic examination was performed (Somatom Definition; Siemens, Erlangen, Germany). Scan measurements are as follows: collimation of 64 x 0.6 mm, slice thickness of 1.5 mm, reconstruction interval of 1.00 mm, pitch of 1.5, and a dose-modulation technique was used to reduce the radiation exposure of 80 kVp, 30 mAs. The estimated radiation exposure was 0.1 mSv. Computed tomography electrocardiogram synchronization was not applied and bolus tracking technique were used so as to maintain radiation dose at a minimum. Contrast medium (6 cc; 300 mgI/mL) was injected at a flow rate of 0.6 mL/s through an antecubital vein. The whole thorax was studied in a scan range that included the epiaortic vessels and the diaphragm. The scan acquisition was started 8 seconds after contrast injection. Examination duration was only for 1.2 seconds. No sedation was required for the procedure. Dual-source computed tomographic angiography revealed hypoplastic aortic arch with severe coarctation of the aorta (3 mm diameter) (Figs 1A–1C, arrows; AA = ascending aorta; DA = descending aorta) and associated atrial septal defect. A small-caliber patent ductus arteriosus was also depicted. Surgical intervention confirmed computed tomographic findings.
