Heartbeat: Imaging complex vascular anatomy in congenital heart disease

Pulmonary hypertension in children negatively impacts clinical outcome and is not always responsive to medical therapy. An entire supplement to Heart 1–3) provides several articles with detailed reviews and consensus statements for management of pediatric pulmonary hypertension. A novel approach to management of pediatric patients with refractory pulmonary hypertension is creation of a shunt from the descending aorta to the left pulmonary artery to unload the suprasystemic pulmonary vascular circuit by shunting into the systemic circulation, often called a “reverse Potts shunt” because the flow direction is the opposite of the shunt created to increase pulmonary blood flow in other types of congenital heart disease. However, creation of this shunt by a transcatheter approach requires advanced cardiac imaging to ensure the two vessels have enough contact area for a successful procedure (figure 1). The imaging approach for this procedure was evaluated in detail in a series of patients by Sizarov and colleagues ( see page 1735 ). Figure 1 Spatial relationship of the vascular walls in a representative patient with severe suprasystemic pulmonary arterial hypertension (PAH). Aorta is colour-coded as red, pulmonary artery as purple and the trachea-bronchi as light-green. (A) is a cranial view and (D) is the left lateral view of the whole three-dimensional (3D) model. (B) is the craniodorsal view of the transverse cut and (C) is left lateral view of the oblique sagittal cut through the left pulmonary artery (LPA) and descending aorta (DAo). Such arrangement with the very short distance between two vessels was the most prevalent among the population of this study. (E and F) are oblique sagittal cuts through the LPA and DAo, respectively, and show the tightest contact …