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Morphologic Assessment of Patent Ductus Arteriosus in Adults Using Retrospectively ECG-Gated Multidetector CT

¹ Department of Cardiology, South West Cardiothoracic Centre, Plymouth National Health Service Trust, Derriford, Plymouth PL6 8DH, United Kingdom.
² Department of Radiology, Plymouth National Health Service Trust, Plymouth PL6 8DH, United Kingdom.

View larger version (99K): [in a new window]   Fig. 1A. —72-year-old man with severely calcified patent ductus arteriosus who presented with New York Heart Association grade III dyspnea [14] and atrial fibrillation. Patient required aortic valve replacement for coexisting aortic stenosis. Because of severe calcification, patient underwent transcatheter duct closure as separate procedure before aortic valve surgery. Axial multiplanar reformation of retrospectively ECG-gated multidetector CT (MDCT) shows severely calcified duct (arrow) extending anteriorly from distal anterior aortic arch.

View larger version (137K): [in a new window]   Fig. 1B. —72-year-old man with severely calcified patent ductus arteriosus who presented with New York Heart Association grade III dyspnea [14] and atrial fibrillation. Patient required aortic valve replacement for coexisting aortic stenosis. Because of severe calcification, patient underwent transcatheter duct closure as separate procedure before aortic valve surgery. Volume-rendered three-dimensional MDCT reconstruction shows calcified duct.

View larger version (119K): [in a new window]   Fig. 2A. —72-year-old man with severely calcified patent ductus arteriosus. Narrowest portion of duct (arrow), at pulmonary insertion, is shown on multiplanar reformations of retrospectively ECG-gated multidetector CT scans obtained in coronal (A), sagittal (B), and axial (C) planes.

View larger version (95K): [in a new window]   Fig. 2B. —72-year-old man with severely calcified patent ductus arteriosus. Narrowest portion of duct (arrow), at pulmonary insertion, is shown on multiplanar reformations of retrospectively ECG-gated multidetector CT scans obtained in coronal (A), sagittal (B), and axial (C) planes.

View larger version (107K): [in a new window]   Fig. 2C. —72-year-old man with severely calcified patent ductus arteriosus. Narrowest portion of duct (arrow), at pulmonary insertion, is shown on multiplanar reformations of retrospectively ECG-gated multidetector CT scans obtained in coronal (A), sagittal (B), and axial (C) planes.

View larger version (83K): [in a new window]   Fig. 3. —22-year-old man with patent ductus arteriosus (arrow) who was evaluated for heart murmur found by army medical personnel. Patient subsequently developed New York Heart Association grade I dyspnea [14]. On axial multiplanar reformation from retrospectively ECG-gated multidetector CT, no ductal calcification is seen. This finding is in marked contrast to severely calcified ducts seen in older patients (Fig. 1A).

View larger version (112K): [in a new window]   Fig. 4A. —72-year-old man with severely calcified patent ductus arteriosus that was morphologic classification type A1 [12]. Volume-rendered three-dimensional (3D) multidetector CT (MDCT) model of trachea was needed for morphologic classification.

View larger version (81K): [in a new window]   Fig. 4B. —72-year-old man with severely calcified patent ductus arteriosus that was morphologic classification type A1 [12]. True sagittal volume-rendered 3D MDCT model in which both duct and trachea are displayed shows exact relationship of patent ductus arteriosus to trachea, which allowed morphologic classification.

View larger version (132K): [in a new window]   Fig. 5A. —Technique of virtual angioscopy is applied to images of noncalcified patent ductus arteriosus in 50-year-old woman with New York Heart Association grade II dyspnea [14] and body mass index of 36. Three-dimensional model of aortic arch and pulmonary trunk generated from multidetector CT (MDCT) data is used for navigation. Duct is indicated by arrow.

View larger version (211K): [in a new window]   Fig. 5B. —Technique of virtual angioscopy is applied to images of noncalcified patent ductus arteriosus in 50-year-old woman with New York Heart Association grade II dyspnea [14] and body mass index of 36. On MDCT virtual angioscopic image, view from distal main pulmonary artery is shown with left pulmonary artery (on right of image) and right pulmonary artery (on left of image) marked with bidirectional arrow. Patent ductus arteriosus (arrow) is visible in main pulmonary artery, adjacent to left pulmonary artery.

View larger version (192K): [in a new window]   Fig. 5C. —Technique of virtual angioscopy is applied to images of noncalcified patent ductus arteriosus in 50-year-old woman with New York Heart Association grade II dyspnea [14] and body mass index of 36. MDCT virtual angioscopic image shows view through noncalcified duct, with pulmonary artery (PA) in foreground, duct (arrows) in center of image, and aorta (AO) visible.

View larger version (165K): [in a new window]   Fig. 6. —72-year-old woman who had severely calcified ductus arteriosus and underwent transcatheter duct closure. Note difference between this multidetector CT virtual angioscopic image of view through calcified duct and view through noncalcified duct seen in same type of image in Figure. 5C. Pulmonary artery (PA) is in foreground; duct, in center of image (arrows); and aorta, (AO) visible through duct.

View larger version (173K): [in a new window]   Fig. 7A. —72-year-old man with patent ductus arteriosus. Transthoracic echocardiograms generated from parasternal short-axis projection obtained at level of aorta (AO) and main pulmonary artery (MPA) were helpful in determining correct diagnosis, but duct was not directly visualized on these or on any other echocardiograms. However, multidetector CT (Figs. 1A, and 1B) showed severe calcification of patent ductus arteriosus and allowed morphology to be classified as type A1 (Figs. 4A, and 4B). Pulmonary valve (PV) (arrow) is seen at top of image, and bifurcation of main pulmonary artery is seen at bottom.

View larger version (156K): [in a new window]   Fig. 7B. —72-year-old man with patent ductus arteriosus. Transthoracic echocardiograms generated from parasternal short-axis projection obtained at level of aorta (AO) and main pulmonary artery (MPA) were helpful in determining correct diagnosis, but duct was not directly visualized on these or on any other echocardiograms. However, multidetector CT (Figs. 1A, and 1B) showed severe calcification of patent ductus arteriosus and allowed morphology to be classified as type A1 (Figs. 4A, and 4B). Diagnosis of patent ductus arteriosus was suggested by presence of diastolic flow originating from left of bifurcation of main pulmonary artery (arrow, left pulmonary artery is on right of image) and flowing up toward transducer.

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