Imaging of the Lungs in People with Congenital Heart Problems

Introduction

A congenital heart defect patient's outcome may be severely affected by congenital or postoperative lung perfusion abnormalities, which may call for specialized therapies. Children with impaired lung perfusion, particularly if it is unilateral, are typically asymptomatic, and neither two-dimensional echocardiography nor chest radiography are very good at picking up on these abnormalities. The need for an accurate and noninvasive method for quantitative evaluation of the relative pulmonary blood flow in patients with a congenital heart defect has been highlighted by the significant advancement in recent years in our ability to directly relieve branch pulmonary artery stenosis, either surgically or with balloon angioplasty. It has been demonstrated that lung perfusion scintigrams utilizing technetium-99m-labeled albumin macro aggregates are a useful technique for this evaluation. In this paper, we share our observations from using this test on a diverse range of individuals with different congenital cardiac abnormalities.

Methods

At the Beilinson Medical Center, lung perfusion scintigrams were used to examine patients with congenital heart defects. The hemodynamic and cine angiographic data, chest X-ray films, two-dimensional and Doppler echocardiograms, and medical records were done. The occurrence of any congenital cardiac abnormality or surgical procedure that could have changed the distribution of pulmonary blood flow to the lungs was the rationale for lung perfusion scintigraphy. patients who had undergone a procedure to increase pulmonary blood flow, such as a systemic to pulmonary artery shunt operation, right ventricular outflow tract reconstruction, full tetralogy repair, or direct anastomosis of systemic venous pathways to the pulmonary arteries (such as a bidirectional Glenn operation or modified Fontan operation); and In each case, the patient or the patient's parents had given their informed consent for the treatment.

Scintigraphy of the Lungs

An intravenous cannula that was placed into a peripheral vein delivered the injection, which was weight-adjusted for the patient. Almost immediately after the radiopharmaceutical agent was injected while the patient was supine, perfusion imaging was started. Using a large field-of-view gamma camera outfitted with a low-energy, all-purpose collimator, a typical multiple-view scan was carried out. The sum of radioactivity in each lung in the front and posterior images were used to calculate lung perfusion. An impartial observer evaluated the unevenness of lung perfusion without consulting chest X-ray findings, hemodynamic data, or cine angiographic results.

Study Using Chest X-rays

An independent pediatric radiologist evaluated the patients' chest X-ray films, which were taken within six months of the lung perfusion scans without any intervening procedure, for pulmonary blood flow in both lung fields without taking into account the calculated results of the lung perfusion scintigrams. The procedure outlined by Implant and Castaneda-Zuniga was used to visually inspect the chest X-ray films. The distribution of arterial blood in each lung was classified as normal, raised, or decreased, and the distribution in the opposing lung field was contrasted. Later, perfusion lung scintigrams were used to correlate the findings with the calculated pulmonary flow distribution.

Cineangiograms

Within six months of the lung perfusion scintigram, thirty patients had cardiac catheterization and cine angiography. Lung perfusion scintigram results and qualitative assessment of pulmonary artery structure were connected. Patients' lung perfusion scintigram results and angiographic results may be connected. There was a high association between anatomical results and the degree of abnormalities in patients (90%) patients had one lung that wasn't getting enough blood flow, which was closely associated with branch pulmonary artery stenosis. According to cine angiography, the increased flow to one lung in two patients was caused by a systemic to pulmonary collateral artery shunt in one patient and a systemic to pulmonary artery shunt in the other. On cine angiography, the pulmonary arteries and lung perfusion scintigram of 12 patients were both normal. Three individuals reported aberrant cine angiographic findings in addition to normal lung perfusion scintigram results.

Journal Information

Journal of Pulmonology, an official publication of the Pulsus group, is a peer-reviewed, open-access journal in the respiratory research fraternity facilitating real-time peer-reviewed information on the subject. 

We accept articles across the discipline but are not limited to:

Asthma, Bronchiectasis, Bronchitis, Chronic Obstructive Pulmonary Disease (COPD), Chronic Hypercapnic respiratory failure (CHRF), Emphysema, Interstitial Lung Diseases, Lung Cancer, Obstructive Sleep Apnea, Pleural Effusion, Pneumoconiosis, Pneumonia, ARDS (acute respiratory distress syndrome), Cystic Fibrosis, Solitary Pulmonary Nodule, Tuberculosis. 

*The “Journal of Pulmonology”

Publishes current research articles related to Pulmonary.

Manuscript Submission link: https://www.pulsus.com/submissions/pulmonology.html