Additional value of three-dimensional rotational angiography in the diagnostic evaluation and percutaneous treatment of children with univentricular hearts

Aims: Complex single ventricle topography, changes in vessel geometry after surgical steps and subsequent stenoses are difficult to visualise with biplane conventional angiography (CA). This study aimed to investigate the additional value of three-dimensional rotational angiography (3DRA) compared to CA for diagnostic and interventional purposes in children with univentricular hearts. Methods and results: Demographic data, clinical data and catheterisation details of both imaging techniques were collected retrospectively. Image quality, interventional success and the additional value of 3DRA were reviewed and scored. Between January 2003 and March 2017, 140 patients underwent 183 CAs and 107 3DRAs. 3DRA image quality was superior to CA with fewer diagnostic angiographies performed (p<0.001). Intervention rate (p<0.001) and interventional success (p=0.03) were higher with 3DRA, while complication rates were similar. Mean radiation was lower in the 3DRA group, reaching significance pre-PCPC. 3DRA was considered of additional value in imaging of cardiovascular anatomy, collaterals, stenoses, and vessel-vessel and vessel-bronchi interactions. Conclusions: In univentricular hearts, 3DRA provides superior image quality when compared to CA. Furthermore, 3DRA is performed with fewer diagnostic angiographies, less radiation and higher interventional success.