Optimal CHD Patient Care Requires Interventional, Surgical Collaboration

July 20, 2023 — A new expert consensus from the Society of Cardiovascular Computed Tomography (SCCT) offers clinical protocol for cardiovascular computed tomography (CCT) to guide intervention in the right ventricular outflow tract (RVOT) in patients with congenital heart disease (CHD). 

“Technical Recommendations for Computed Tomography Guidance of Intervention in the Right Ventricular Outflow Tract: Native RVOT, Conduits and Bioprosthetic Valves” offers imaging and reporting standards for surgical or transcatheter pulmonary valve replacement (TPVR), including dysfunctional RVOT conduits and bioprosthetic valves, as well as native and patched RVOTs. 

The goal of the multi-specialty collaboration of three contributing societies – SCCT, the Society for Cardiovascular Angiography and Intervention (SCAI), and the Congenital Heart Surgeons’ Society (CHSS) – is to optimize CCT image acquisition, minimize diagnostic risk and standardize reporting to guide pulmonary valve replacement (PVR), a common procedure for patients with CHD and pulmonary valve dysfunction. 

“CT is an essential tool for evaluation of all forms of congenital heart disease” said B. Kelly Han, MD, FSCCT, writing group co-chair and corresponding author. “The heart team concept that has been instrumental in optimizing intervention in aortic, mitral, and tricuspid vales – has now been applied to the RVOT. The unique collaboration with adult and pediatric surgeons (CHSS) and interventionalists (SCAI) optimizes interventional planning for all patients with RVOT dysfunction across the age spectrum." 

According to the writing group, led by Han and Santiago Garcia, MD, the white paper standardizes reporting and integrates CCT guidance into TPVR clinical practice, much like previously published guidance for transcatheter aortic valve replacement (TAVR). 

Along with reviewing contemporary consensus statements and guideline documents, the consensus also summarizes definitions of RVOT dysfunction as assessed by multi-modality imaging techniques, and offers a procedural overview for imagers. 

Other recommendations include: 

• CCT scan acquisition, data processing and image reconstruction; 
• standardized reporting on CCT of the dysfunctional RVOT; and 
• standardized CCT assessment of coronary artery anatomy in preparation for surgical or TPVR. 

Read the full document, published in the Journal of Cardiovascular Computed Tomography (JCCT). 

For more information: www.scct.org 

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