Page 61 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
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and Miettinen) to obtain the following: cardiac output, pulmonary ow, pulmonary vascular resistance, and systemic vascular resistance all indexed to body surface area. The relationship of pulmonary ow to systemic ow and relationship of pulmonary to systemic vascu- lar resistance was also calculated. For validation, retrospective col- lection of hemodynamic information was recorded and calculated in PedCath (v7.7.3) for 50 patients, age 3 months to 17 years old. Indications selected for analysis included pulmonary hypertension, atrial septal defect, and single ventricle physiology. Hemodynamic calculations were processed with the hemodynamics software and comparisons of di erence between the two programs made.
Results: No signi cant di erence between PedCath and the hemo- dynamics software were found. The standard error for all variables compared was <0.007.
Conclusion: We have successfully developed and validated a reliable and simple tool in the catheterization the catheterization laboratory to obtain quick and accurate hemodynamic information.
#0114
OUT WITH THE OLD AND IN WITH THE NEW: QUANTIFYING RADIATION EXPOSURE AND ITS IMPACT ON PEDIATRIC PATIENTS UNDERGOING CARDIAC CATHETERIZATION
James C. Fudge, Emily L. Marshall, David Borrego, Wesley E. Bolch
University of Florida, Gainesville, FL, USA
Objective: The application of advanced dosimetry methods to track radiation organ doses for patients undergoing cardiac catheterization.
Background: As the eld of interventional cardiology in congenital heart disease continues to grow, we are becoming more aware of the potential secondary impacts of interventional treatments such as the long-term risks of radiation exposure. Currently, most institutions use metrics such as the kerma area product meter, dose at the reference point, and uoroscopy time to track radiation. These values, while useful in charting quality control and improvements, have inherent limitations for broader application. The reporting of patient organ doses is now available to provide clinicians with an accurate method for dose tracking and the potential for patient risk modelling into the future.
Methods: A radiation dose reporting system developed at the researchers’ institution was implemented within the institution’s pediatric cardiac catheterization laboratory. Organ dose report- ing was performed for a group of 40 patients within the laboratory population and a subgroup analysis was performed on 15 trans- plant patients undergoing cardiac catheterization in order to further evaluate clinical dose metrics.
Results: Among the entire group, the highest reported organ doses seen were in the lungs, heart, adrenals, liver and the esophagus. Among the 15 transplant patients further analysed, the average dose at the reference point for this patient group was 284 mGy. Average organ doses were 19 mGy, 12 mGy, 6 mGy, 7 mGy, and 17 mGy to the lungs, esophagus, liver, adrenals, and heart respectively. The patient
with the highest doses to these 5 organs had a reported dose at the reference point of 297 mGy, which was the sixth highest in the group of 15 indicating poor correlation between these dose metrics.
Conclusions: There is poor correlation between the commonly used dose metric of dose at the reference point and the dose metric of patient organ doses. Patient organ doses provide a more accurate measure of patient radiation dose and thus may provide a more e ec- tive way of evaluating the future risk of patient radiation exposure.
#0115
INTRA-PROCEDURAL 3D ROTATIONAL ANGIOGRAPHY: SETUP TIME AND THE IMPACT OF LEARNING CURVE IN A DEDICATED “CORE TEAM” APPROACH FOR ADULT CONGENITAL HEART DISEASE INTERVENTIONS
Amy Vaughn1, Ponraj Chinnadurai3, Akanksha Thakkar1, Nakeisha Washington1, Gary Monteiro1, John Breinholt2, Huie Lin1
1Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
2Department of Pediatrics, The University of Texas Health Science Center, Houston, TX, USA
3Advanced Therapies, Siemens Medical Solutions USA Inc.,, Ho man Estates, IL, USA
Background: Intra-procedural 3D Rotational angiography (3DRA) in the cardiac catheterization laboratory has been shown to add clini- cal value especially during complex structural and congenital heart disease interventions. Although 3D information enhances 2D uo- roscopy, some limitations that may preclude its optimal utilization include exposure to additional radiation, time needed for setup and the associated learning curve.
Methods: All adult congenital cardiac procedures performed in a single institution with intra-procedural 3DRA imaging between December 2014 and August 2016 were retrospectively reviewed. Additional 3DRA setup time was de ned as the di erence in the time stamps between 3DRA acquisition and preceding 2D uoroscopic/ cine acquisition. Case times and total radiation dose from uoros- copy and 3DRA were noted for each procedure.
Results: A total of 21 patients underwent 3D rotational angiography acquisition during the study period for procedures including diag- nostic pulmonary angiogram for CTEPH evaluation, trans-catheter pulmonary valve implantation, aortic coarctation and pulmonary vein stenting. The median additional setup time for 3D rotation angi- ography was 9.87 minutes (25th percentile: 7.87 min, 75th percentile: 19.02). Typical reasons for additional setup time include: selection of optimal imaging and contrast injection protocols, patient position- ing, imaging setup and acquisition. The median radiation dose area product (DAP) was 2815.9 microGy-m2 (25th percentile: 1918, 75th percentile: 3603). There was a trend towards reduction in the set up time as operators progressed along the learning curve. Median time to case start and total in-room time were 38 minutes and 212 minutes respectively.
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306