Tetralogy of Fallot

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Case Study
Patient History
One-year-old baby girl diagnosed with Tetra-
logy of Fallot at one month of age.
The patient underwent a catheterization with
balloon dilation of the pulmonary valve and
subsequent angioplasty of the pulmonary
arteries. Later, the proximal right and left pul-
monary arteries were surgically patched and
a complete repair with a ventricular septal
defect closure and homograft replacement of
the pulmonary valve was performed.
Treatment
Patient was readmitted for elective cardiac
catheterization to image her pulmonary arte-
rial tree in its entirety for treatment planning
of future interventions. Using a single plane
Artis zeego, the technologist performed a
5-second rotational 3D image of the main
pulmonary artery using a 5 french x 80-cm
Berman catheter at a rate of 4 ml per second;
2:1 diluted contrast solution. Purpose was to
obtain a complete 3D image of the surgically
placed homograft valve and the right and left
pulmonary arteries.
continued on next page
1 DSA of the pulmonary vessels tree.
Tetralogy of Fallot
Courtesy of Farhouch Berdjis, M.D., Dept. of Pediatric Cardiology, St. Joseph Hospital, Orange, CA, USA Cardiology
2
Clinical Impressions
In order to obtain a complete assessment of
the pulmonary artery tree, selective injec-
tions in the main, right, and left pulmonary
arteries are traditionally necessary. This re-
quires at least three, and perhaps up to five,
separate angiograms each using 1 cc con-
trast/kg. The 3D angiography required 2 cc
per kg with far less dose for the patient.
2a+b Complete 3D imaging of the right and left pulmonary arteries to verify the placement of the homograft valve.
Tetralogy of Fallot
Courtesy of Dr. Farhouch Berdjis, Dept. of Pediatric Cardiology, St. Joseph Hospital, Orange, CA, USA Cardiology
3
In addition, even with
multiple angios, you cannot
obtain the same comfort
level and understanding
of the complex pulmonary
artery anatomy. The 3D
angio demonstrated the
locations and extent of the
stenoses in detail. Rotating
the image on the screen
and then correlating the
flat detector angle results
in a accurate road map on
the screen; it cannot be
duplicated with traditional
biplane angiography.
Farhouch Berdjis, M.D.,
Dept. of Pediatric Cardiology,
St. Joseph Hospital, Orange, CA, USA
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