Background: Tetralogy of Fallot (TOF) is a complex congenital heart condition characterized by four major anatomical abnormalities. Accurate preoperative imaging is critical for optimal surgical outcomes, with transthoracic echocardiography (TTE), computed tomography angiography (CTA), and conventional catheter angiography (CCA) being the primary diagnostic tools. This study aimed to compare the diagnostic utility of TTE, CTA, and CCA in preoperative evaluations of TOF patients, focusing on anatomical parameters, imaging accuracy, and patient outcomes. Methods: A retrospective, single-center analysis included TOF patients under one year of age who underwent complete repair between January 2021 and December 2024. Preoperative imaging with TTE, CTA, and CCA was analyzed for parameters including pulmonary artery diameters, Nakata index, McGoon ratio, and Z-scores. Radiation exposure, procedure duration, contrast volume, and complications were documented. Statistical analyses were performed to assess the comparative accuracy and safety of these modalities. Results: All patients underwent TTE (n = 127), while CTA was performed in 86 patients and CCA in 41 patients. Among 127 patients, 62% were male, with a mean age of 5.81 ± 2.15 months. On TTE, CTA and CCA provided statistically similar measurements of the pulmonary annulus, main pulmonary artery, and branch diameters, with no significant differences in the Nakata index and McGoon ratio. CTA had a shorter procedure duration (3.1 ± 0.58 min) and lower radiation dose (1.19 ± 0.22 mSv) compared to CCA (20.73 ± 11.12 min; 5.48 ± 1.62 mSv). CTA successfully identified major aortopulmonary collateral arteries (MAPCAs) in 10% of patients and detected additional pulmonary pathologies, such as subsegmental atelectasis in 12%. Access site complications were observed in 10% of CCA cases but were absent in CTA evaluations. Conclusions: CTA emerges as a highly effective and non-invasive alternative to CCA for preoperative assessment of TOF, offering comparable anatomical accuracy with significantly reduced procedural risks, radiation exposure, and contrast volume. Combining TTE and CTA provides comprehensive diagnostic coverage, minimizing the need for invasive procedures and enhancing surgical planning. These findings underscore the evolving role of CTA in the management of congenital heart disease, contributing to improved patient safety and outcomes.

Background: Conotruncal anomalies frequently involve extracardiac vascular structures that are critical for surgical planning yet incompletely assessed by transthoracic echocardiography (TTE). We evaluated the incremental diagnostic value of CT angiography (CTA) beyond TTE using intraoperative findings as the reference standard. Methods: In this single-center retrospective study, 239 children who underwent surgical repair of a conotruncal anomaly and had both preoperative TTE and CTA were analyzed. The incremental contribution of CTA was graded as none, minor, or major by two independent reviewers. Diagnostic performance of each modality was compared with operative findings for coronary artery anomalies, right aortic arch, aortic arch hypoplasia, interrupted aortic arch, and pulmonary artery atresia, non-confluence, and hypoplasia. Results: CTA provided incremental information beyond TTE in 232 patients (97.1%), classified as major in 51.9% and minor in 45.2%; interobserver agreement was almost perfect (quadratic-weighted κ = 0.825). CTA was superior for coronary artery anomalies (sensitivity 91.7% vs. 50.0%), branch pulmonary artery hypoplasia (97.3% vs. 89.3%), and aortic arch hypoplasia (100% vs. 87.5%; all p < 0.05), and identified aortopulmonary collaterals and a persistent left superior vena cava more frequently than TTE. The two modalities performed comparably for aortic arch sidedness and interrupted aortic arch, and pulmonary atresia. Conclusions: CTA provides additional, operatively confirmed anatomical information beyond TTE in the majority of children with conotruncal anomalies, with the greatest value for extracardiac vascular anatomy. Rather than replacing echocardiography, CTA should be regarded as a complementary modality that refines preoperative anatomical assessment.

Background: Pulmonary hypertension (PHT) is a rare but serious condition in children, requiring early diagnosis to prevent right ventricular failure. Non-invasive imaging modalities such as computed tomography angiography (CTA) have gained importance in assessing vascular changes, including main pulmonary artery (MPA) dilatation, increased vessel stiffness, and elevated pulmonary vascular resistance, which are characteristic of pulmonary hypertension (PHT). Objective: This study aimed to evaluate the diagnostic value of the main pulmonary artery-to-ascending aorta (MPA/AA) and main pulmonary artery-to-descending aorta (MPA/DA) ratios on CTA in pediatric patients with confirmed PHT. Methods: In this retrospective cohort study, 76 pediatric patients who underwent both cardiac catheterization and thoracic CTA were included. Patients were divided into PHT (mean pulmonary artery pressure ≥ 25 mmHg) and non-PHT groups. Vascular measurements were obtained from CTA, and MPA/AA and MPA/DA ratios were calculated. Statistical analyses included Mann–Whitney U tests and ROC curve analysis. Results: The MPA diameter and MPA/AA and MPA/DA ratios were significantly higher in the PHT group compared to controls (p < 0.05). ROC analysis showed strong diagnostic performance for both ratios. The MPA/DA ratio had an AUC of 0.927 with 78.5% sensitivity and 94% specificity at a cut-off value of 1.85. The MPA/AA ratio had an AUC of 0.896 with 76.5% sensitivity and 95% specificity at a cut-off value of 1.25. Conclusions: Both MPA/AA and MPA/DA ratios are reliable non-invasive indicators of pediatric PHT, with the MPA/DA ratio demonstrating slightly higher diagnostic accuracy. These findings support the use of CTA-derived vascular ratios, especially MPA/DA, as effective screening tools in clinical practice.

Introduction: Post-CPB bleeding remains a critical challenge in neonatal cardiac surgery, and early detection of coagulopathy to guide transfusion decisions may offer significant benefits. We hypothesized that routine use of intraoperative ROTEM as a decision parameter would reduce perioperative transfusions, modulate transfusion patterns and improve the outcomes in newborns undergoing congenital heart surgery. Methods: This retrospective cohort study was conducted at a single-center tertiary academic hospital and included 58 consecutive neonates who underwent congenital cardiac surgery with cardiopulmonary bypass between April 2022 and October 2023. Interventions: Coagulation parameters before surgery, ACT during surgery and Rotational thromboelastometry (ROTEM) for ROTEM group just before weaning from CPB were evaluated. Transfusion of platelets, fresh frozen plasma, cryopresipitate and fibrinogen concentrate were determined. Comparison: Patients with and without ROTEM-guided transfusion were compared in terms of blood product transfusion. Measurements and Main Results: In this study, 58 patients (21 females, 37 males) were analyzed. Preoperatively, hemoglobin and hematocrit levels were significantly higher in the conventional group ( p = 0.032, p = 0.033). Postoperatively, the Rotem group had higher hemoglobin, hematocrit, and ACT levels, while platelets were significantly lower ( p = 0.0182). Fewer patients in the ROTEM group required transfusions of PRBCs, platelet concentrates, and cryoprecipitate ( p < 0.05). Additionally, the Rotem group had significantly lower median intraoperative cryoprecipitate and platelet concentrates use compared to the conventional group ( p < 0.001). Conclusion: ROTEM analyses before discontinuation of CPB facilitate hemostasis management and reduce the use of allogenic blood products during neonatal cardiac surgery and the immediate postoperative period.

Objectives: The objective of this study was to evaluate the impact of combining near-infrared spectroscopy (NIRS) and bispectral index (BIS) for monitoring cerebral oxygenation and detecting ischemia during pediatric cardiac surgery with cardiopulmonary bypass (CPB). Methods: A prospective, single-center study was conducted between March 01, 2024, and July 01, 2024, involving 50 pediatric patients undergoing congenital heart surgery. Cerebral oxygenation was continuously monitored using NIRS and BIS at 6 time points during surgery: T1 (entry), T2 (immediately after CPB initiation), T3 (deepest hypothermic temperature), T4 (post-rewarming), T5 (end of surgery), and T6 (postoperative intensive care unit [ICU]). Central venous saturation, hematocrit (Htc), temperature, mean arterial pressure (MAP), and lactate levels were also monitored. The primary outcomes included correlations between cerebral oxygenation parameters and neurological outcomes within 3 months. Results: The study was conducted with a total of 50 children cases, of which 56% (n=28) were male, and 44% (n=22) were female. The age of the cases ranged from 6 to 200 months, with a mean 42.4±52.7 months. Weight measurements ranged from 14.2 to 65 kg, with a mean of 16.3±14.3 kg. The average CPB duration was 96.1±34.8 min. The cases had an average ICU stay of 3.2±2 days. Upon reviewing the final status, it was found that there were no mortality among the patients and only three patients experienced transient neurological complications, which resolved without long-term deficits. NIRS values remained stable between 55% and 65% during surgery. BIS monitoring detected no significant decreases, supporting the absence of severe ischemia. Conclusion: Combining NIRS and BIS in pediatric cardiac surgery enhances cerebral perfusion monitoring and enables early detection of ischemic events, potentially reducing postoperative neurological complications. Larger studies are needed to validate these findings and further assess the role of intraoperative parameters such as Htc and MAP in preventing cerebral ischemia.