Author + information
- Received August 17, 2017
- Revision received November 2, 2017
- Accepted November 27, 2017
- Published online February 14, 2018.
- aDepartment of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, Canada
- bDepartment of Paediatrics, Division of Cardiology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Canada
- ↵∗Address for correspondence:
Dr. Christopher Z. Lam, Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
- bidirectional cavopulmonary connection
- congenital heart disease
- pediatric, pulmonary arteriovenous malformation
Pulmonary arteriovenous malformations and systemic-to-pulmonary venovenous shunts are right-to-left shunts that can compromise the superior bidirectional cavopulmonary connection (BCPC). Computed tomography is indicated in critically ill patients or when noncardiac issues are the primary indication for imaging. With computed tomography, injection of contrast media through an upper extremity can lead to dense undiluted contrast in the superior vena cava and pulmonary arteries, resulting in undesirable streak artifacts. However, an unintended benefit is that right-to-left shunts are unveiled. Contrast media normally dilutes passing through a capillary bed. Dense contrast in the pulmonary veins or left atrium implies contrast has bypassed the pulmonary capillary bed, via pulmonary arteriovenous malformations or systemic-to-pulmonary venovenous shunts (Figures 1 to 3⇓⇓⇓, Online Videos 1 and 2). Although we routinely use foot injections to avoid limitations of arm injections for BCPC evaluation, we incidentally noticed right-to-left shunting when contrast was arm injected for noncardiac indications. Here we present 3 cases of right-to-left shunts after BCPC highlighting this phenomenon, which has not been previously reported.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 17, 2017.
- Revision received November 2, 2017.
- Accepted November 27, 2017.
- 2018 American College of Cardiology Foundation