International Journal of Advances in Medicine

Dashottar S et al. Int J Adv Med. 2017 Apr;4(2):425-432

http://www.ijmedicine.com pISSN 2349-3925 | eISSN 2349-3933

DOI: http://dx.doi.org/10.18203/2349-3933.ijam20170424
Original Research Article

Role of 256 slice CT scan in pre and postoperative evaluation of

congenital cardio-vascular anomalies: our experience at
a tertiary care teaching hospital
Sunita Dashottar1, Ajay K. Singh2*, K. P. S. Senger2, Col J. Debnath3

1
Department of Radio-diagnosis, Command Hospital, Lucknow, Uttar Pradesh, India
2
Department of Radio-diagnosis, Army Hospital R and R, Delhi, India
3
Professor Armed Forces Medical College, Pune, Maharashtra, India

Received: 15 January 2017

Accepted: 25 January 2017

*Correspondence:
Dr. Ajay K. Singh,
E-mail: ltcolaksingh@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Ultrafast CT (UCT) scan plays an important role in the evaluation of congenital cardiovascular
anomalies (CCVA). A major advantage of higher slice multi-detector CT (MDCT), is improved temporal as well as
spatial resolution, that helps accurately to delineate complex cardiac and extra-cardiac anomalies with relative ease.
Hence this study was aimed to highlight the utility of UCT in the evaluation of congenital cardiovascular anomalies in
a large series of patients.
Methods: All consecutive patients with suspected CCVA were evaluated by cardiac CT angiography (CCTA) on 256
slice CT scan in a multispecialty tertiary care teaching institute from June 2013 to December2015.
Results: A total of 160 cases of CCVA were evaluated by CCTA. 50 patients had multiple anomalies. A total of 216
anomalies were diagnosed. Tetralogy of fallot (TOF) dominated the list of CCVAs (60, 28%) than the other
abnormalities. Of them, 25 patients underwent Blalock Taussig (BT) shunt surgeries, 20 patients underwent total
repair operation like Rastelli’s operation or augmentation of pulmonary arteries (PAs) while 15 patients were lost to
follow up. Most of the patients diagnosed with CCVAs were managed successfully based on the imaging diagnosis of
the cardiovascular anomaly.
Conclusions: Ultrafast CT scans have immense role in the evaluation of various types of congenital cardiovascular
anomalies. It is particularly helpful in the evaluation of extra-cardiac systemic and pulmonary arterial and venous
system, postoperative complications, to see the status of shunts, stents and conduits.

Keywords: Congenital cardiovascular anomalies, Cardiac CT angiography, Ultrafast CT scan

INTRODUCTION Management of congenital cardio-vascular anomalies

(CCVA) primarily depends upon the diagnosis at any
Incidence of congenital heart disease is 6-8 per 1000 of stage of patient care; therefore, the assessment should
live births. Survival of the patients with CHD have involve the various imaging modalities and should be
improved over a period of time due to early diagnosis by considered as complimentary to each other.2
the various imaging modalities like echo, CCTA
(coronary computed tomography angiography), cardiac Echo is the initial imaging modality of choice for the
magnetic resonance imaging (CMRI) and coronary diagnosis of most of the CCVA as it is widely available,
angiogram (CA).1 cheap, non-invasive and provides immediate high

International Journal of Advances in Medicine | March-April 2017 | Vol 4 | Issue 2 Page 425
 Dashottar S et al. Int J Adv Med. 2017 Apr;4(2):425-432

resolution anatomic and physiological information.3 METHODS

However, due to its limited acoustic access, echo is not
sufficient for the evaluation of extra-cardiac vascular This prospective cross sectional observational study was
structures.4 carried out at a tertiary care cardiovascular centre of
Armed Forces Medical Services from June 2013 to
CA is primarily used to provide hemodynamic December 2015. A total of 160 patients of various types
information and for the evaluation of the extra-cardiac of CCVA referred to the radiology department for CCTA
vascular structures.5 CA has limitations due to its 2D during the study period were included in the study.
nature, overlapping of adjacent cardiovascular structures
and simultaneous evaluation of the systemic and All the neonates and pediatric patients with suspected
pulmonary vasculature. The disadvantages of CA over CCVA were initially evaluated by echocardiography
CCTA are higher catheter related complications, larger (echo) in the cardiology department. Patients who were
volume of contrast, longer duration of sedation and higher detected to have CCVA on echo were further evaluated
radiation dose.6-8 Because of these limitations of echo and by CCTA. Catheter angiography was done for further
CA, CTCA and MRI are considered to be alternative, evaluation in a select group of cases where CCTA
complementary as well as problem solving diagnostic evaluation was deemed equivocal.
tools for the evaluation of CCVA.9
Cardiac CT angiography
CMRI can accurately give anatomical and physiological
information which cannot be provided by the echo and CCTA were done on 256 slice CT scanner (Philips
CA alone.10 CMRI can provide functional information Healthcare, Brilliance). Young pediatric patients were
and evaluation of the myocardial functions.11 But the given mild sedation while older children were responded
greatest challenge of CMRI is motion artifacts from to verbal assurance. In the pediatric patients 1 to 1.5
cardiac and respiratory movements. In infants and ml/kg of low (300 mg I/ml) or iso-osmolar contrast (320
pediatric patients. Various other disadvantages are its mg I/ml) was injected through the antecubital vein at a
higher cost, limited availability, general anesthesia for rate of 1.5 to 2.5 ml/sec followed by 20-30 ml saline
longer duration and image degrading artifacts due to bolus chase. The tube voltage varied from 80 to 100kVp
implanted stents and coils.12,13 and tube current varied according to the weight of the
patient. Mean scanning time was 02-03 sec. After
The utmost challenge in imaging the beating heart has completion of the scan, images were reconstructed in
been the main motivating force for the innovation of various orthogonal as well as non-orthogonal planes
ultrafast CT scanners. The latest ultrafast CT scanners including three-dimensional volume-rendered (3D-VR)
have significantly improved the diagnostic capabilities of images, two dimensional (2D) maximum intensity
CCTA due to its high gantry speed, improved spatial and projection (MIP). All images were analyzed at the
temporal resolution and has been found to correlate well workstation by two radiologists trained in MDCT and
with conventional CA. Ultrafast CTCA can acquire cardiac imaging. CCTA findings of all patients were
volume acquisition of the entire heart and the coronary tabulated and analyzed later.
arterial tree within 3-4 seconds with higher temporal and
spatial resolution than MRI.14 256 and 320 Slices CT RESULTS
scanner have brought a revolution in cardiac imaging
where the heart can been scanned in one tube rotation or A total of 160 patients of various types of CCVA
one heart beat and total scanning time is 3-4 seconds. The underwent CCTA during the study period. Total number
reconstructed images like MIP and 3D-VR images are of of CCVA detected on CCTA was 216 as 50 patients had
great help for the pre-operative planning and post- multiple anomalies. A total of 21 different types of
operative evaluation of the complications, status of stent, CCVA were found in our study as presented in Table 1
shunts and conduits. Tachycardia and arrhythmias are the and depicted in figures from Figure 1 to Figure 15 along
main limiting factors with these CT scanners. However, with their managements. Tetralogy of fallot (TOF)
these limiting factors have partially been overcome by the dominated the list of CCVA (60, 28%), followed by
dual source CT (DSCT) scanners. Somatom definition anomalies of pulmonary arteries (40, 18.5%), anomalous
flash (Siemens) is a latest ultrafast CT scanner where the pulmonary venous drainage (30, 14%), coarctation of
entire heart can be scanned in a fraction of heart beat and aorta (25, 11.5%), coronary anomalies (10, 5%) and
total scanning time is 0.25 to 0.27sec. venacaval anomalies (5%). All other anomalies were
individually less than 5% of the total CCVA. Majority of
CCTA can be considered as first imaging modality for the patients were managed in our institution except those
certain conditions like – evaluation of the MAPCAS, who were lost to follow up.
vascular rings and in patients with pacemaker or metallic
implants.12 The present study was conducted to Out of sixty cases of TOF, twenty-five patients
accentuate the utility of UCT in the evaluation of underwent Blalock Taussig (BT) shunt surgeries, twenty
congenital cardiovascular anomalies in a large series of patients underwent total repair operation like Rastelli’s
patients. operation or augmentation of pulmonary arteries (PAs)

International Journal of Advances in Medicine | March-April 2017 | Vol 4 | Issue 2 Page 426
 Dashottar S et al. Int J Adv Med. 2017 Apr;4(2):425-432

while fifteen patients were lost to follow up as given in

Table 2. Out of twenty-five patients who underwent
minor surgeries, one patient died in early postoperative
period, nine patients were lost to follow up, four patients
developed blockage of BT shunt after one year, while
eleven patients had patent shunt.

Figure 3: Operated case of TOF with augmentation of

pulmonary arteries (Pas). a) axial 2D MIP image
shows severe stenosis at the right PA (RPA) origin
with small calibre RPA and mild stenosis at the LPA
origin b) Volume rendered (VR) 3D image shows the
same.
Figure 1: Case of tetralogy of Fallot (TOF) with
Ballock Taussing (BT) Shunt. a) sagittal reformatted
image shows non-opacification of BT shunt except the
upper portion suggestive of non-patent BT shunt;
b) coronal oblique reformatted image ofa 58 yrs
malecase of TOF with BT shunt showspatent BT
shunt between left subclavian artery (LSCA) and left
pulmonary artery (LPA).

Figure 4: Case of right ventricular outflow tract

stenosis, associated saccular aneurysm of the
infundibular region. a) 2-D MIP coronal oblique
image shows stenosis of RVOT with saccular
aneurysm (white arrow) arising from the origin of
MPA b) Catheter angiography showing the same.

Out of twenty patients who underwent total repair, six

patients died during the operation or in early
postoperative period due to various complications, three
Figure 2: Operated case of TOF with right ventricle- patients developed stenosis of the right ventricle-
pulmonary artery (RV-PA) Conduit (Rastelli pulmonary artery (RV-PA) conduits, one had stenosis of
operation). a) axial 2D maximum intensity projection augmented PAs as seen in Figure 3a and 3b while five
(MIP) image shows stenosis of the mid portion of RV- patients were lost to follow-up. Out of four patients who
PA conduit (red arrow) with mild stenosis at the LPA developed stenosis in the conduits/augmented PA, three
origin b) 3D Volume rendered (VR) image showing patients improved with balloon angioplasty while one
the RV-PA conduit (yellow arrow). patient underwent redo surgery.

International Journal of Advances in Medicine | March-April 2017 | Vol 4 | Issue 2 Page 427
 Dashottar S et al. Int J Adv Med. 2017 Apr;4(2):425-432

Figure 7: Case of VSD with transposition of great

arteries (TGA). a) VR image is showing aorta arising
Figure 5: Cases of partial/total anomalous pulmonary from the RV and MPA from the LV with over-riding
venous return (PAPVC/TAPVC). a) 3D VR image of MPA seen b) MIP coronal image showing the same.
ofsupra-cardiac PAPVR showing right pulmonary Left superior vena cava (LSVC) is also seen.
veins draining into SVC b) 2D coronal MIP image of
infra-cardiac PAPVR showing RIPV draining into
IVC (inverted sword sign), c) 3D VR image of a
supra-cardiac & cardiac type of TAPVR showing
LSPV draining into LSCV (white arrow) and all other
PVs forming common trunk and draining through
coronary sinus into RA (red arrow) d) operated case
of cardiac type of TAPVR developed stenosis at the
site of opening of common trunk into LA.

Figure 6: Axial reformatted images of truncus Figure 8: Case of Aorto-pulmonary (A-P) window -
arteriosus. a) single trunk arising from LV b) MPA 3D VR image is showing wide communication
arising from the single trunk and then branching into between the ascending aorta and MPA distal to the
two pulmonary arteries. origin.

International Journal of Advances in Medicine | March-April 2017 | Vol 4 | Issue 2 Page 428
 Dashottar S et al. Int J Adv Med. 2017 Apr;4(2):425-432

Figure 11: Case of atrio-ventricular canal defect

(AVCD) with double outlet right ventricle (DORV).
a) 2-D axial MIP image showing large ASD & VSD
with common opening of both atria with both the
ventricles b) 2-D coronal MIP image showing Aorta &
MPA arising from right ventricle.

Figure 9: 3D VR image of coarctation of aorta. a)

showing preductal type of coarctation b) coarctation
with hypoplastic arch c) interrupted hypoplastic arch
d) absent arch of aorta with dilated PDA supplying
the descending thoracic aorta (DTA). Major arch
vessels are arising from the ascending aorta (AA).

Figure 12: Axial image of cortriatriatum shows single

atrium with multiple floating membranes in the left
atrial chamber.

Figure 10: Anomalous origin of coronary arteries. a)

& b) volume rendered images showing anomalous
origin of RCA (right coronary artery) from the Figure 13: Vascular rings. a) 2-D axial MIP image
proximal ascending aorta above the left coronary cusp showing aberrant right subclavian artery compressing
c) common origin of RCA & left coronary artery esophagus b) 2-D axial MIP image showing aberrant
(LCA) from left coronary sinus d) anomalous origin of left subclavian artery with Kommeral’s diverticula
left anterior descending (LAD) artery from proximal and right sided aortic arch are forming vascular ring
portion of RCA. around trachea.

International Journal of Advances in Medicine | March-April 2017 | Vol 4 | Issue 2 Page 429
 Dashottar S et al. Int J Adv Med. 2017 Apr;4(2):425-432

Figure 15: An operated case of dextrocardia with

single atrium & large ventricular septal defect (VSD)
with double outlet left ventricle (DOLV) and Glenn
shunt. a) axial image is showing single atrium and
large VSD b) axial image showing resected MPA near
Figure 14: Case of anomalous origin of pulmonary
its origin (yellow arrow) with normally opacified
trunk from right subclavian artery (RSCA) in a case
MPA & LPA and non opacified RPA (white arrow)c)
of TOF. a) Volume rendered image showing the origin
of pulmonary trunk from the dilated right subclavian coronal oblique 2D MIP showing aorta & MPA
artery. MPA is coursing downwards and branching arising from LV with MPA resected near its origin
(red arrow) d) Coronal 2D MIP image showing
into two Pas supplying both the lungs b) MIP coronal
peripherally opacified SVC anastomosed to RPA
oblique image showing the same.
(Green arrow - Glenn shunt).

Table 1: Types of congenital cardiovascular anomalies in the study participants.

Types of congenital cardiovascular anomalies Total no of CCVA detected by CCTA: 216

Tetralogy of Fallot 60 (28%)
Anomalies of pulmonary arteries 40 (18.5%)
Anomalous pulmonary venous drainage 30 (14%)
Anomalies of pulmonary veins 5 (2%)
Truncus arteriosus 4 (2%)
Transposition of great arteries 4 (2%)
A-P Window 4 (2%)
Coarctation of aorta 25 (11.5%)
Congenital aneurysm of aorta 4 (2%)
Coronary anomalies 10 (5%)
Single ventricle 2 (1%)
Single atrium 4 (2%)
AVCD 2 (1%)
Double outlet right ventricle 4 (2%)
Double outlet left ventricle 2 (1%)
Cortriatriatum 1 (<1%)
Pulmonary agenesis 1 (<1%)
Hypogenetic lung 2 (1%)
Sequestered Lung 1 (<1%)
Vascular ring 3 (1%)
Vena Cava anomaly 10 (5%)

Table 2: Type of surgery in TOF cases and their complications.

Type of surgery in Total no of

No complications Mortality Complications Lost to follow
TOF cases
04 (Blockage of shunt
BT Shunt surgery 25 11 01 09
after 01year)
Major surgery 20 05 06 04 (stenosis of conduit) 05
Lost to follow up 15 -

International Journal of Advances in Medicine | March-April 2017 | Vol 4 | Issue 2 Page 430
 Dashottar S et al. Int J Adv Med. 2017 Apr;4(2):425-432

DISCUSSION classify the types and can help in surgical planning of

interrupted arch or COA.17,22 It can also demonstrate the
Ultrafast CT (UCT) scan plays an important role in the various complication like residual/re-coarctation or
evaluation of congenital cardiovascular anomalies pseudo-coarctation formation and is also very useful in
(CCVA), particularly the extra-cardiac vascular the evaluation of stent patency and various complications
anomalies. UCT enables accurate delineation of complex like stent migration or occlusion/stenosis.15,23
anatomy of cardiovascular system both before and after
surgery especially in pediatric patients.9,15 Cardiac CT In this study, we had two known cases of Marfan’s
angiography (CCTA) is the modality of choice for syndrome associated with huge aneurysm of the aortic
evaluation of postoperative complications and also to root and AA. Bentall surgery was done replacing the
evaluate the status of conduits, shunts and stents. aortic root along with the valves with artificial conduit
and the coronary arteries (CAs) were re-anastomosed to
In the present study, tetralogy of Fallot, is the commonest the conduit.
congenital cardiac anomaly which was evaluated by
CCTA in our department. In TOF due to pulmonary In this study, we had an interesting case of two-year-old
atresia or pulmonary stenosis, the blood supply to the male baby, known case of DS with situs inversus and
lungs comes from the various collaterals arising from the dextrocardia had single atrium with physiological single
aorta and/or other systemic arteries know as major aorto- ventricle due to large VSD as depicted in Figure 15a.
pulmonary collateral arteries (MAPCAS).15 This is easily Aorta and MPA both were arising from the LV
diagnosed by CCTA as it can demonstrate the caliber and suggestive of DOLV as seen in Figure 15c. Due to this
number of the mapcas. Hence, it is the modality of choice high pressure blood was flowing into the pulmonary
for the evaluation of mapcas before embolization or circulation leading to pulmonary congestion. To reduce
reimplantation.12,15-17 CT is also very useful for pre and the pulmonary congestion, the MPA was resected near its
post- operative evaluation of PAPVR/TAPVR.4,13,18 origin and was permanently closed (Fig 15bandc). Then
the superior vena cava (SVC) was anastomosed to the
In this study, we had a case of Down syndrome (DS) with RPA so as to divert one third of the systemic blood into
TOF in which augmentation of MPA was done; two years the pulmonary circulation to maintain the oxygenation as
later developed severe stenosis of right pulmonary artery in Figure 15d. This is known as Glenn shunt which is
(RPA) and mild stenosis of left pulmonary artery (LPA) usually done in single ventricle.
as shown in Figure 3. This condition was improved with
balloon angioplasty. ECG-gated CTA can accurate delineate the origin and
course as well as the various anomalies of the CAs.24 It
CTA can accurately delineate the presence, patency and was found that noninvasive CTA was more accurate in
caliber of pulmonary arteries which is required for correct the demonstration of the CAs than catheter
surgical planning and it also helps in the pre and angiography.25
postoperative evaluation of pulmonary artery stenosis or
dilatation.16,19 In this study, we observed an interesting CONCLUSION
case of 2 cm size saccular aneurysm of the infundibular
region associated with right ventricular out flow tract Ultrafast CT scan has become the imaging modality of
obstruction (RVOTO) and large ASD which was initially choice for evaluation of CCVA in pediatric and adult
missed on CT angiography. However, catheter patients. It is primarily meant to evaluate the extra-
angiography clearly demonstrated the saccular aneurysm cardiac systemic and pulmonary arterial as well as venous
and retrospectively was demonstrated on CT angiography system. It is the modality of choice for the evaluation of
as shown in Figure 4 and then the patient was operated shunts, stents, conduits and post-operative complications.
thereafter.
ACKNOWLEDGEMENTS
In the study, a case report of 1 year old baby with large
ASD associated with aneurysmal dilatation of main The authors would like to acknowledge statistician Mrs.
pulmonary trunk (MPA) compressing the left main Sucharita Suresh for her invaluable contribution.
bronchus against the descending thoracic aorta (DTA)
leading to complete collapse of the left lung was Funding: No funding sources
observed and this was corrected by operation with Conflict of interest: None declared
complete regression of the extrinsic compression over the Ethical approval: The study was approved by the
left main bronchus.20 institutional ethics committee

CCTA can accurately diagnose the arch hypoplasia, REFERENCES

interrupted or absent arch and coarctation of aorta. It can
accurately give the measurements of the aorta as well as 1. Marelli AJ, Mackie AS, Ionescu-Ittu R, Rahme E,
demonstrate the PDA and arterial collaterals in COA.21 It Pilote L. Congenital Heart Disease in the General
can accurately depicts the site and degree of stenosis6,

International Journal of Advances in Medicine | March-April 2017 | Vol 4 | Issue 2 Page 431
 Dashottar S et al. Int J Adv Med. 2017 Apr;4(2):425-432

Population: Changing Prevalence and Age computed tomography and stress myocardial single
Distribution. Circulation. 2007;115:163-72. photon emission computed tomography. Clin Nucl
2. Ntsinjana HN, Hughes ML, Taylor AM. The Role Med. 2009;34(2):96-8.
of Cardiovascular Magnetic Resonance in Pediatric 15. Gaca AM, Jaggers JJ, Dudley LT, Bisset GS 3rd.
Congenital Heart Disease. J Cardiovascular Mag Repair of congenital heart disease: a primer. Part 2
Resonance. 2011;13:51. Radiology 2008; 248:44-60
3. Lai WW, Geva T, Shirali GS, Frommelt PC, Humes 16. Greil GF, Schoebinger M, Kuettner A, Schaefer JF,
RA, Brook MM, et al. Guidelines and Standards for Dammann F, Claussen CD, et al. Imaging of
Performance of a Pediatric Echocardiogram: A aortopulmonary collateral arteries with high-
Report from the Task Force of the Pediatric Council resolution multidetector CT. Pediatr Radiol.
of the American Society of Echocardiography. J Am 2006;36:502-9.
Soc Echocardiogr. 2006;19:1413-30. 17. Goo HW, Park IS, Ko JK, Park IS, Yoon CH,
4. Leschka S, Oechslin E, Husmann L, Desbiolles L, Hopkins KL, et al. CT of congenital heart disease:
Marincek B, Genoni M, et al. Pre- and postoperative normal anatomy and typical pathologic conditions.
evaluation of congenital heart disease in children RadioGraph. 2003;23:147-65.
and adults with 64-section CT. RadioGraph. 18. Lee T, Tsai IC, Fu YC, Jan SL, Wang CC, Chang Y,
2007;27:829-46. et al. Using multidetector-row CT in neonates with
5. Lock JLKJ, Perry SB. Diagnostic and Interventional complex congenital heart disease to replace
Catheterisation in Congenital Heart Disease. 2nd diagnostic cardiac catheterization for anatomical
edition. Springer; 1999. investigation: initial experiences in technical and
6. Hollingsworth CL, Yoshizumi TT, Frush DP, Chan clinical feasibility. Pediatr Radiol. 2006;36:1273-82.
FP, Toncheva G, Nguyen G, et al. Pediatric cardiac- 19. Ley S, Zaporozhan J, Arnold R, Eichhorn J, Schenk
gated CT angiography: assessment of radiation JP, Ulmer H, et al. Preoperative assessment and
dose. Am J Roentgenol. 2007;189:12-8. follow-up of congenital abnormalities of the
7. Mehta R, Lee KJ, Chaturvedi R, Benson L. pulmonary arteries using CT and MRI. Eur Radiol.
Complications of pediatric cardiac catheterization: a 2007;17:151-62.
review in the current era. Catheter Cardiovasc 20. Dashottar S, Singh AK, Suhag V, Sunita BS, Singh
Interv. 2008;72:278-85. RK. Unusual Case of Congenital Aneurysm of
8. Gaca AM, Jaggers JJ, Dudley LT, Bisset GS 3rd. Proximal Pulmonary Artery Causing Lung Collapse.
Repair of congenital heart disease: a primer. Part 1. J Cardiovas Dis Res. 2015;6(1):31-6.
Radiol. 2008;247:617-31. 21. RyersonL, Harder J. Totally anomalous pulmonary
9. Dillman JR, Hernandez RJ. Role of CT in the venous return. Cardiol Young. 2005;15:304–5.
Evaluation of Congenital Cardiovascular Disease in 22. Yang DH, Goo HW, Seo DM, Yun TJ, Park JJ, Park
Children. Am J Roentgenol. 2009;192(5):1219-31. IS, et al. Multislice CT angiography of interrupted
10. Kilner PJ, Geva T, Kaemmerer H, Trindade PT, aortic arch. Pediatr Radiol. 2008;38:89-100.
Schwitter J, Webb GD. Recommendations for 23. Shih MC, Tholpady A, Kramer CM, Sydnor MK,
cardiovascular magnetic resonance in adults with Hagspiel KD. Surgical and endovascular repair of
congenital heart disease from the respective working aortic coarctation: normal findings and appearance
groups of the European Society of Cardiology. Eur of complications on CT angiography and MR
Heart J. 2010;31:794-805. angiography. Am J Roentgenol. 2006;187:788.
11. Cheitlin MD, Armstrong WF, Aurigemma GP, 24. Sparrow P, Merchant N, Provost Y, Doyle D,
Beller GA, Bierman FZ, Davis JL, et al. Nguyen E, Paul N. Cardiac MRI and CT features of
ACC/AHA/ASE 2003 guideline update for the inheritable and congenital conditions associated
clinical application of echocardiography: summary with sudden cardiac death. Eur Radiol.
article: a report of the American college of 2009;19:259-70.
cardiology/American heart association task force on 25. Schmitt R, Froehner S, Brunn J, Wagner M,
practice guidelines (ACC/AHA/ASE committee to Brunner H, Cherevatyy O, et al. Congenital
update the 1997 guidelines for the clinical anomalies of the coronary arteries: imaging with
application of echocardiography). J Am Coll contrast-enhanced, multidetector computed
Cardiol. 2003;42:954-70. tomography. Eur Radiol. 2005;15:1110-21.
12. Taylor AM. Cardiac imaging: MR or CT? Which to
use when. Pediatr Radiol. 2008;38(3):433-8.
13. Gilkeson RC, Ciancibello L, Zahka K. Multidetector Cite this article as: Dashottar S, Singh AK, Senger
CT evaluation of congenital heart disease in KPS, Col Debnath J. Role of 256 slice CT scan in pre
pediatric and adult patients. Am J Roentgenol and postoperative evaluation of congenital cardio-
2003;180:973-80. vascular anomalies: our experience at a tertiary care
14. Chen ML, Lo HS, Su HY, Chao IM. Coronary teaching hospital. Int J Adv Med 2017;4:425-32.
artery fistula: assessment with multidetector

International Journal of Advances in Medicine | March-April 2017 | Vol 4 | Issue 2 Page 432