Non-sedated, free breathing cardiac CT for evaluation of complex congenital heart disease in neonates

Background: Neonates with complex congenital heart disease (CHD) are at risk of adverse events from anesthesia. CT angiography (CTA) performed free breathing and without sedation has not been reported for evaluation of complex CHD in neonates. Objectives: The aim was to evaluate the image quality and risk of free breathing, non-sedated cardiac CTA for definition of CHD in the neonatal period and to determine accuracy compared with interventional findings. Methods: This is a combined retrospective prospective single institution review of all non-sedated, free breathing cardiac CT angiograms performed in patients <1 month of age with complex CHD. Diagnosis, scan acquisition parameters, image quality (1- to 4-point scale), adverse events, radiation dose estimates, and accuracy compared with operative and interventional catheterization findings were recorded. Results are reported as median and interquartile range. Results: Nineteen non-sedated, free breathing, neonatal cardiac CT angiograms were performed during the time of review. All studies were diagnostic with a mean image quality score of 1.1 +/- 0.3. Median total procedural dose-length product was 11 (range, 10-14), CT dose index volume was 0.47 (range, 0.31-0.5). Median unadjusted radiation dose was 0.15 mSv (range, 0.14-0.2 mSv), age- and size-adjusted radiation dose was 0.86 mSv (range, 0.78-1.1 mSv). No adverse events and no discrepancies compared with surgical or catheterization findings were found in the 17 of 19 patients that had subsequent intervention. Conclusions: Cardiac CTA can be performed in the neonatal period free breathing and without sedation. Image quality is excellent, and there is high accuracy compared with surgical and catheterization findings at the time of intervention. (C) 2013 Society of Cardiovascular Computed Tomography. All rights reserved.