Children´s Cardiac Center of National Heart Institute, Slovakia
Marek Kardos has completed his MD studies at the age of 24 years from University of Comenius in Bratislava, Slovakia. He is 5th year resident of radiology at Department of Functional Diagnostics of Children´s Cardiac Center in Bratislava. In 2012, he participated in 6 weeks observance program organized by Children´s Hospital of Philadelphia. He has published several papers focusing on CT visualization of congenital heart diseases.
Over the years, Fontan operation has become established as a revolutionary therapy for patients with univentricular heart. The patients who have undergone the procedure suffer from many complications. Pulmonary branch stenosis is one of the most frequent complication in Fontans. The traditional imaging technique for the pre- and post- operative evaluation of patients with congenital heart diseases (CHD) was catheter angiography but this has been replaced by echocardiography for most conditions. MRI is an excellent diagnostic tool particularly for evaluation of young children with CHD who will require several follow-up examinations in their lifetime. Moreover, the diagnostic capabilities of MRI are limited in the presence of surgical devices and implanted stents due to the signal dropout in the region of the stent. Evaluation of in-stent restenosis by CT is optimal. Visualization of stent in these patients is due to Fontan physiology challenging. For the accurate diagnosis of in-stent restenosis of implanted stents in pulmonary arteries or in fenestration in Fontans acquiring uniform and good enhancement of these vascular structures is essential. In our low sample study (eight examinations), for homogenous enhancement of Fontan pulmonary arteries and Fontan tract we decided to use 1-minute delay scan with right antecubital application of contrast agent. Optimal enhancement when the stent was possible to evaluate intraluminally was achieved in seven CT examinations. This study demonstrates that CT angiography is a fast, accurate and repro- ducible method in the evaluation of patients with Fontan circulation, and implanted stent in pulmonary arteries or in fenestration.