Abstract：
The role of preoperative cardiac computed tomography (CT) in neonates with pulmonary atresia and intact ventricular septum (PA-IVS) remains unclear. This study was aimed to elaborate the role of preoperative CT-derived anatomical and functional findings in planning treatment strategies in neonates with PA-IVS. The presence of ventriculocoronary arterial connections was evaluated by CT. CT-derived ventricular volumetric parameters were compared and correlated with echocardiographic tricuspid valve (TV) z-score in 12 neonates with PA-IVS. Cardiac CT and echocardiographic findings were compared between definite surgical types (median follow-up, 4 years). Ventriculocoronary arterial connections were identified with CT in 58.3% of cases (7/12) and associated with higher incidence of Fontan procedure (42.9%, 3/7) and high mortality (28.6%, 2/7). The CT-derived and echocardiographic TV z-scores exhibited a high correlation (R = 0.924, p < 0.001). The CT-derived right ventricle (RV) volume and RV-left ventricle volume ratio also displayed high correlations (R = 0.875 and 0.867, respectively; p < 0.001) with echocardiographic TV z-score. More positive echocardiographic TV z-score, high CT-derived RV end-diastolic volume and RV-left ventricle volume ratio, and low CT-derived left ventricular end-diastolic volume were observed in biventricular surgery group (N = 2), compared to Fontan operation (N = 3) and 1.5 ventricular surgery (N = 3) groups, and mortality cases (N = 3). Preoperative CT-derived coronary artery anatomy and ventricular volumetric parameters may supplement treatment planning in neonates with PA-IVS especially when multifactorial decision including echocardiographic TV z-score is in a gray zone.W.
摘要：
术前心脏计算机断层扫描（CT）在肺动脉闭锁和完整室间隔（PA-IVS）新生儿中的作用尚不清楚。这项研究旨在阐述术前CT衍生的解剖和功能发现在PA-IVS新生儿计划治疗策略中的作用。通过CT评估心室冠状动脉连接的存在。比较了12例PA-IVS新生儿的CT得出的心室容积参数，并将其与超声心动图三尖瓣（TV）z评分相关联。在明确的手术类型之间比较心脏CT和超声心动图检查结果（中位随访，4年）。58.3％的病例（7/12）通过CT确定了心室冠状动脉连接，并且与Fontan手术的较高发生率有关（42.9％，3/7）和高死亡率（28.6%，2/7).CT衍生和超声心动图TVz-评分表现出高度相关性(R=0.924,p<0.001)。CT衍生的右心室（RV）体积和RV-左心室体积比也与超声心动图TVz评分高度相关（分别为R=0.875和0.867；p<0.001）。更积极的超声心动图电视z评分，高CT来源的右心室舒张末期容积和右心室容积比，在双心室手术组（N=2）中观察到低CT衍生的左心室舒张末期容积，与Fontan手术（N=3）和1.5心室手术（N=3）组相比，和死亡病例（N=3）。术前CT衍生的冠状动脉解剖结构和心室容积参数可以补充PA-IVS新生儿的治疗计划，尤其是当包括超声心动图TVz评分在内的多因素决策处于灰色区域时。
