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Ojha V, Ganga KP, Kumar S. Computed tomography imaging of complications in postoperative cyanotic congenital heart diseases - A pictorial essay. Clin Imaging 2020; 71:1-12. [PMID: 33166896 DOI: 10.1016/j.clinimag.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/06/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
Cross-sectional imaging plays an essential role in the diagnosis and management of various structural and functional changes that occur in the postoperative period after palliative or corrective surgical procedures performed for congenital heart diseases (CHD). Although echocardiography is the mainstay for the evaluation of CHD, it is limited by poor acoustic window post-surgery in addition to being operator dependent. Computed tomography (CT) allows for the comprehensive evaluation of the post-surgical anatomy and complications after repair for cyanotic CHD. Radiologists and cardiac imagers should be familiar with these expected changes after surgeries performed for various cyanotic CHDs, to obtain diagnostic quality cardiac CT images and to promptly recognise the abnormal post-operative appearances in this patient population. In this review, we describe the various CT features of complications that can be encountered after repair of cyanotic CHDs.
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Affiliation(s)
- Vineeta Ojha
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Kartik P Ganga
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi 110029, India.
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Urmeneta Ulloa J, Álvarez Vázquez A, Martínez de Vega V, Cabrera JÁ. Evaluation of Cardiac Shunts With
4D
Flow Cardiac Magnetic Resonance: Intra‐ and Interobserver Variability. J Magn Reson Imaging 2020; 52:1055-1063. [DOI: 10.1002/jmri.27158] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 01/03/2023] Open
Affiliation(s)
- Javier Urmeneta Ulloa
- Cardiology Department. Quirón‐Salud University Hospital European University of Madrid Madrid Spain
| | - Ana Álvarez Vázquez
- Radiology Department. Quirón‐Salud University Hospital European University of Madrid Madrid Spain
| | - Vicente Martínez de Vega
- Radiology Department. Quirón‐Salud University Hospital European University of Madrid Madrid Spain
| | - José Ángel Cabrera
- Cardiology Department. Quirón‐Salud University Hospital European University of Madrid Madrid Spain
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Validation of 4D flow CMR against simultaneous invasive hemodynamic measurements: a swine study. Int J Cardiovasc Imaging 2019; 35:1111-1118. [PMID: 30963352 PMCID: PMC6534524 DOI: 10.1007/s10554-019-01593-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/28/2019] [Indexed: 12/25/2022]
Abstract
The purpose of this study was to compare invasively measured aorta flow with 2D phase contrast flow and 4D flow measurements by cardiovascular magnetic resonance (CMR) imaging in a large animal model. Nine swine (mean weight 63 ± 4 kg) were included in the study. 4D flow CMR exams were performed on a 1.5T MRI scanner. Flow measurements were performed on 4D flow images at the aortic valve level, in the ascending aorta, and main pulmonary artery. Simultaneously, flow was measured using an invasive flow probe, placed around the ascending aorta. Additionally, standard 2D phase contrast flow and 2D left ventricular (LV) volumetric data were used for comparison. The correlations of cardiac output (CO) between the invasive flow probe, and CMR modalities were strong to very strong. CO measured by 4D flow CMR correlated better with the CO measured by the invasive flow probe than 2D flow CMR flow and volumetric LV data (4D flow CMR: Spearman’s rho = 0.86 at the aortic valve level and 0.90 at the ascending aorta level; 2D flow CMR: 0.67 at aortic valve level; LV measurements: 0.77). In addition, there tended to be a correlation between mean pulmonary artery flow and aorta flow with 4D flow (Spearman’s rho = 0.65, P = 0.07), which was absent in measurements obtained with 2D flow CMR (Spearman’s rho = 0.40, P = 0.33). This study shows that aorta flow can be accurately measured by 4D flow CMR compared to simultaneously measured invasive flow. This helps to further validate the quantitative reliability of this technique.
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Evaluation of atrial septal defects with 4D flow MRI-multilevel and inter-reader reproducibility for quantification of shunt severity. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2018; 32:269-279. [PMID: 30171383 PMCID: PMC6424937 DOI: 10.1007/s10334-018-0702-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/10/2018] [Accepted: 08/16/2018] [Indexed: 01/08/2023]
Abstract
Purpose With the hypothesis that 4D flow can be used in evaluation of cardiac shunts, we seek to evaluate the multilevel and interreader reproducibility of measurements of the blood flow, shunt fraction and shunt volume in patients with atrial septum defect (ASD) in practice at multiple clinical sites. Materials and methods Four-dimensional flow MRI examinations were performed at four institutions across Europe and the US. Twenty-nine patients (mean age, 43 years; 11 male) were included in the study. Flow measurements were performed at three levels (valve, main artery and periphery) in both the pulmonary and systemic circulation by two independent readers and compared against stroke volumes from 4D flow anatomic data. Further, the shunt ratio (Qp/Qs) was calculated. Additionally, shunt volume was quantified at the atrial level by tracking the atrial septum. Results Measurements of the pulmonary blood flow at multiple levels correlate well whether measuring at the valve, main pulmonary artery or branch pulmonary arteries (r = 0.885–0.886). Measurements of the systemic blood flow show excellent correlation, whether measuring at the valve, ascending aorta or sum of flow from the superior vena cava (SVC) and descending aorta (r = 0.974–0.991). Intraclass agreement between the two observers for the flow measurements varies between 0.96 and 0.99. Compared with stroke volume, pulmonic flow is underestimated with 0.26 l/min at the main pulmonary artery level, and systemic flow is overestimated with 0.16 l/min at the ascending aorta level. Direct measurements of ASD flow are feasible in 20 of 29 (69%) patients. Conclusion Blood flow and shunt quantification measured at multiple levels and performed by different readers are reproducible and consistent with 4D flow MRI. Electronic supplementary material The online version of this article (10.1007/s10334-018-0702-z) contains supplementary material, which is available to authorized users.
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Nigro Stimato V, Didier D, Beghetti M, Tissot C. Atresia of the aortic arch in 4-year-old child: a clinical case study. Front Pediatr 2015; 3:19. [PMID: 25853109 PMCID: PMC4367175 DOI: 10.3389/fped.2015.00019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 02/23/2015] [Indexed: 12/18/2022] Open
Abstract
Atresia of the aortic arch is a rare congenital heart defect with a high mortality when associated with other intracardiac defects. Cardiac magnetic resonance (CMR) provides the exact anatomy of the aortic arch and collateral circulation and is useful to diagnose-associated aortic arch anomalies. This report describes the case of a 4-year-old child with atresia of the aortic arch, referred to our institution with the diagnosis of aortic coarctation and bicuspid aortic valve. On clinical exam, the femoral pulses were not palpable and there was a significant differential blood pressure between the upper and lower limbs. The echocardiography showed a severely stenotic bicuspid aortic valve but was limited for the exact description of the aortic arch. CMR showed absence of lumen continuity between the ascending and descending aorta distal to the left subclavian artery, extending over 5 mm, with the presence of a bend in the arch and diverticulum on either side of the zone of discontinuity, suggesting the diagnosis atresia of the aortic arch rather than coarctation or interruption. The patient benefited from a successful surgical commissurotomy of the aortic valve and reconstruction of the aortic arch with a homograft. The post-operative CMR confirmed the good surgical result. This case emphasizes the utility of CMR to provide good anatomical information to establish the exact diagnosis and the operative strategy.
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Affiliation(s)
- Vittoria Nigro Stimato
- Cardiology Unit, Child and Adolescent Department, Geneva University Hospital , Geneva , Switzerland
| | - Dominique Didier
- Magnetic Resonance Unit, Department of Radiology, Geneva University Hospital , Geneva , Switzerland
| | - Maurice Beghetti
- Cardiology Unit, Child and Adolescent Department, Geneva University Hospital , Geneva , Switzerland
| | - Cécile Tissot
- Cardiology Unit, Child and Adolescent Department, Geneva University Hospital , Geneva , Switzerland
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Contrast-Enhanced MR Angiography of Cavopulmonary Connections in Adult Patients With Congenital Heart Disease. AJR Am J Roentgenol 2012; 199:W565-74. [DOI: 10.2214/ajr.11.7503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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van der Hulst AE, Roest AAW, Westenberg JJM, Kroft LJM, de Roos A. Cardiac MRI in postoperative congenital heart disease patients. J Magn Reson Imaging 2012; 36:511-28. [PMID: 22903653 DOI: 10.1002/jmri.23604] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Annelies E van der Hulst
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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9
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Śpiewak M, Biernacka EK, Małek ŁA, Petryka J, Kowalski M, Miłosz B, Żabicka M, Miśko J, Rużyłło W. Right ventricular outflow tract obstruction as a confounding factor in the assessment of the impact of pulmonary regurgitation on the right ventricular size and function in patients after repair of tetralogy of fallot. J Magn Reson Imaging 2011; 33:1040-6. [DOI: 10.1002/jmri.22532] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Fratz S, Hess J, Schuhbaeck A, Buchner C, Hendrich E, Martinoff S, Stern H. Routine clinical cardiovascular magnetic resonance in paediatric and adult congenital heart disease: patients, protocols, questions asked and contributions made. J Cardiovasc Magn Reson 2008; 10:46. [PMID: 18928522 PMCID: PMC2579426 DOI: 10.1186/1532-429x-10-46] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 10/17/2008] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) of patients with congenital heart disease (CHD) has become routine clinical practice. However, existing CMR protocols focus predominantly on patients with ischemic heart disease, and information is limited on the types of patient with CHD who benefit from CMR investigation, and in what ways. Therefore the aim of this study was to answer the questions: What type of patients were studied by CMR in a centre specializing in paediatric and adult CHD management? What questions were asked, which protocols were used and were the questions successfully answered? To answer these questions, we conducted a cohort study of all 362 patients that received routine clinical CMR during 2007 at the Department of Paediatric Cardiology and Congenital Heart Disease at the Deutsches Herzzentrum München. RESULTS Underlying diagnosis was in 33% Fallot's tetralogy, 17% aortic coarctation, 8% Ebstein's disease, 6% Marfan's disease, 4% single ventricle with Fontan-like circulation, and 32% others. Median age was 26 years (7 days - 75 years). Ventricular volumes were assessed in 67% of the patients; flow in 74%; unknown anatomy only in 9%; specific individual morphology of known anatomy in 83%; myocardial fibrosis in 8%; stress-induced myocardial perfusion defects in 1%. Only in 3% of the cases the question could not be fully answered. CONCLUSION Contrary to common belief, routine CMR of patients with CHD was not requested to address global anatomical questions so much as to clarify specific questions of morphology and function of known anatomy. The CMR protocols used differed markedly from those widely used in patients with ischemic heart disease.
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Affiliation(s)
- Sohrab Fratz
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - John Hess
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Annika Schuhbaeck
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Christine Buchner
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Eva Hendrich
- Department of Radiology, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Stefan Martinoff
- Department of Radiology, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Heiko Stern
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
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11
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Gutiérrez FR, Ho ML, Siegel MJ. Practical Applications of Magnetic Resonance in Congenital Heart Disease. Magn Reson Imaging Clin N Am 2008; 16:403-35, v. [DOI: 10.1016/j.mric.2008.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Postoperative Imaging in Cyanotic Congenital Heart Diseases: Part 2, Complications. AJR Am J Roentgenol 2007; 189:1361-9. [DOI: 10.2214/ajr.07.2105] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Lovato L, Giardini A, La Palombara C, Russo V, Gostoli V, Gargiulo G, Picchio FM, Fattori R. Role and effectiveness of cardiovascular magnetic resonance in the diagnosis, preoperative evaluation and follow-up of patients with congenital heart diseases. Radiol Med 2007; 112:660-80. [PMID: 17673954 DOI: 10.1007/s11547-007-0171-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 11/20/2006] [Indexed: 10/23/2022]
Abstract
The substantial advances in the medical and surgical treatment of congenital heart diseases have dramatically improved patients' life expectancy, as well as increased the number of those needing lifelong monitoring to identify complications and residual defects. Magnetic resonance imaging (MRI) is an ideal imaging modality for the follow-up of these young patients owing to its noninvasiveness, high reproducibility and morphological and functional accuracy. This paper describes the most appropriate MRI techniques and sequences for the study of cardiovascular heart diseases on the basis of an analysis of MRI studies carried out between January 2003 and June 2006 on 274 patients affected by all of the main congenital cardiovascular malformations, as well as a review of the literature. The advantages of MRI with respect to other imaging techniques, the problems encountered and the main clinical applications and indications of MRI, with special reference to the most common disease entities, are then discussed to define the role, the utility and the future perspectives of this imaging technique in the study of congenital heart diseases.
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Affiliation(s)
- L Lovato
- US di Radiologia Cardiovascolare, Università di Bologna, Bologna, Italy.
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Samyn MM. A review of the complementary information available with cardiac magnetic resonance imaging and multi-slice computed tomography (CT) during the study of congenital heart disease. Int J Cardiovasc Imaging 2005; 20:569-78. [PMID: 15856644 DOI: 10.1007/s10554-004-7021-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The incidence of congenital heart disease is approximately 4-6 per 1000 new births; however, the number of people living with congenital heart disease (CHD) is increasing, because of improved diagnosis, medical, and surgical management. While echocardiography continues to be the mainstay of non-invasive imaging, cardiac MRI (cMRI) and computed tomography (CT) have taken on increasing roles in the diagnosis of congenital heart disease in infants, children, and importantly, adults who may have limited echocardiographic windows, especially if post-operative. Cardiac MRI and multi-slice CT can complement the diagnostic information obtained by echocardiography and invasive cardiac catheterization. Post-operative imaging of CHD is especially enhanced by the spin echo MRI techniques, while gradient cine echo MRI imaging allows functional information that is not encumbered by geometric assumptions. Phase contrast (velocity encoding) cardiac MRI data can provide information about flow, allowing accurate determination of regurgitation and shunt volume. Gadolinium enhanced cMRI or three-dimensional reconstructed images from multi-slice CT angiography allow excellent delineation of vascular structures in complex heart disease. Coronary imaging, while possible with both modalities, appears more facile with fast CT imaging. This article reviews the literature to provide an assessment of the special techniques and considerations needed during the conduct of cardiac MRI/MRA and multi-slice CT examinations during the diagnosis of congenital heart disease in pediatric and adult patients.
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Affiliation(s)
- Margaret M Samyn
- Pediatric Cardiology/Radiology, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, USA.
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15
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Thunberg P, Wigström L, Ebbers T, Karlsson M. Correction for displacement artifacts in 3D phase contrast imaging. J Magn Reson Imaging 2002; 16:591-7. [PMID: 12412037 DOI: 10.1002/jmri.10187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To correct for displacement artifacts in 3D phase contrast imaging. MATERIALS AND METHODS A 3D phase contrast pulse sequence was modified so that displacements of velocity measurements were restricted to one direction. By applying a postprocessing method, displaced measurements could be traced back to their accurate positions. Flow studies were performed using a phantom that generated flow through a stenosis, directed oblique relative to the phase and frequency encoding directions. Velocity profiles and streamline visualization were used to compare displaced and corrected velocity data to a reference. RESULTS Velocity profiles obtained from the original measurement showed skewed profiles due to the displacement artifact, both at close proximity to the orifice as well as further downstream. After correction, concordance with the reference improved considerably. CONCLUSION The displacement artifact, which restricts the accuracy of phase contrast measurements, can be corrected for using the proposed method. Correction of the phase contrast velocity data may improve the accuracy of subsequent flow analysis and visualization.
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Affiliation(s)
- Per Thunberg
- Department of Biomedical Engineering, Orebro University Hospital, Orebro, Sweden.
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16
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Paelinck BP, Lamb HJ, Bax JJ, Van der Wall EE, de Roos A. Assessment of diastolic function by cardiovascular magnetic resonance. Am Heart J 2002; 144:198-205. [PMID: 12177633 DOI: 10.1067/mhj.2002.123316] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The assessment of diastolic heart function has been hampered by multiple difficulties. Cardiovascular magnetic resonance (CMR) is a new, noninvasive technique to study cardiac function. METHODS The literature on CMR for the analysis of diastolic function and its clinical applications is extensively reviewed. RESULTS Analysis of ventricular filling velocity and volume flow, volumetric assessment of ventricular chamber volume, analysis of 3-dimensional myocardial strains, and assessment of myocardial energy content are numerous validated applications of CMR. With the advent of real-time imaging and automated analysis of myocardial strains, CMR tagging is a promising method to assess regional diastolic function. Today, many CMR techniques are leaving the experimental or developmental stage rapidly and becoming clinically available for the evaluation of diastolic function in heart disease. CONCLUSIONS CMR is emerging as a highly accurate and reproducible noninvasive 3-dimensional technique for the assessment of diastolic function.
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Gutierrez FR, Siegel MJ, Fallah JH, Poustchi-Amin M. Magnetic resonance imaging of cyanotic and noncyanotic congenital heart disease. Magn Reson Imaging Clin N Am 2002; 10:209-35. [PMID: 12424944 DOI: 10.1016/s1064-9689(01)00007-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
MRI has become an important imaging tool that complements echocardiography in the noninvasive evaluation of congenital heart defects. It can play a crucial role in diagnosis by assessing anatomic and functional features in CHD and identifying complications and postoperative sequelae. The performance and application of cardiac MRI require not only knowledge of the clinical question that needs to be addressed but knowledge of the anatomic characteristics of a variety of congenital heart lesions. A knowledge of the advantages and disadvantages of the different imaging sequences also is important so as to optimize and expedite the examination.
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Affiliation(s)
- Fernando R Gutierrez
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA.
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Aeba R, Katogi T, Hashizume K, Iino Y, Kawada S, Yuasa Y. Individualized total cavopulmonary connection technique for patients with asplenia syndrome. Ann Thorac Surg 2002; 73:1274-80; discussion 1280-1. [PMID: 11996270 DOI: 10.1016/s0003-4975(01)03583-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Outcomes after univentricular repair for patients with asplenia syndrome remain unsatisfactory, not only because of clinical difficulties in patient selection, but also secondary to technical difficulties in the separation of the systemic and pulmonary circulations, particularly with the rerouting technique for the inferior systemic veins. METHODS Between February 1995 and May 2000, a total of 14 consecutive patients with asplenia syndrome underwent bidirectional cavopulmonary connection with obliteration of additional pulmonary blood flow, followed by a total cavopulmonary connection. The rerouting technique for inferior systemic venous blood flow was individualized to optimize laminar nonturbulent flow characteristics in the pathway, and to minimize prosthetic load and suture load on the atrial wall. The lateral tunnel or tube conduit technique was used in an extraatrial, intra-extraatrial, or intraatrial fashion. No fenestration was applied. RESULTS No hospital mortality was observed. Systemic venous flow was evaluated using magnetic resonance angiography, revealing no signs of obstruction, turbulence, or stasis either in or near the reconstructed pathways, irrespective of the rerouting technique. Postoperative catheterization revealed favorable hemodynamics including an inferior vena cava pressure of 13 +/- 2 mm Hg and arterial oxygen saturation of 93.4% +/- 3.5% at room air. All patients have remained free of symptoms, although 1 patient died of acute septic complications 3.5 years after the procedure. CONCLUSIONS The complexity of cardiac anomalies in asplenia syndrome warrants individualization of the total cavopulmonary connection technique used in reconstruction of the inferior systemic venous pathway. Optimizing flow characteristics in the pathway should be a priority. A staging approach allows suitable selection of candidates for univentricular repair.
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Affiliation(s)
- Ryo Aeba
- Division of Cardiovascular Surgery, Keio University, Tokyo, Japan.
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Steiner RM, Reddy GP, Flicker S. Congenital cardiovascular disease in the adult patient: imaging update. J Thorac Imaging 2002; 17:1-17. [PMID: 11828207 DOI: 10.1097/00005382-200201000-00001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Robert M Steiner
- Department of Radiology, the Weill Medical College of Cornell University, New York, NY.
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Hazekamp MG, Kurvers MM, Schoof PH, Vliegen HW, Mulder BM, Roest AA, Ottenkamp J, Dion RA. Pulmonary valve insertion late after repair of Fallot's tetralogy. Eur J Cardiothorac Surg 2001; 19:667-70. [PMID: 11343950 DOI: 10.1016/s1010-7940(01)00656-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To analyze the results of pulmonary valve insertion late after initial repair of Fallot's tetralogy. Pulmonary insufficiency (PI) after correction of Fallot's tetralogy is usually well tolerated in the short term, but is associated with symptomatic right ventricular dilatation and an increased risk of ventricular arrhythmias over longer periods of time. METHODS From 1993 to July 2000, 51 patients were reoperated for PI at a mean age of 25.7+/-11.9 years. The mean age at initial repair was 6.4+/-7.2 years. Patients with a conduit inserted at initial operation, with absent pulmonary valve syndrome or with a more than moderate ventricular septal defect at reoperation were excluded from the study. A cryopreserved pulmonary (96%) or aortic (4%) homograft was implanted in the orthotopic position with the use of cardiopulmonary bypass 19.3+/-9.1 years (2.7-40.3 years) after initial correction. Preoperative symptoms (New York Heart Association, NYHA class), degree of PI (echo-Doppler, MRI), right ventricular dimensions (MRI) and QRS duration were compared to findings at last follow-up. RESULTS Follow-up is complete and had a mean duration of 1.7+/-1.4 years. Hospital mortality was 2%. No serious morbidity occurred. Severe PI was present preoperatively in all patients. At last follow-up echo-Doppler studies showed PI to be absent or trivial in 96% and mild in 4% of patients. In 13 patients MRI studies were performed both pre- and postoperatively: in this group PI was reduced from a mean of 48 to 4%. After 6 months NYHA capacity class had improved significantly from 2.3+/-0.6 to 1.4+/-0.5. After 1 year end-diastolic and end-systolic right ventricular volumes were reduced significantly. Right ventricular ejection fraction and QRS duration remained unchanged. CONCLUSIONS PI late after correction of Fallot's tetralogy may lead to serious symptomatic right ventricle dilatation. After pulmonary homograft insertion right ventricular dimensions decrease rapidly and functional improvement is observed in almost all patients.
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Affiliation(s)
- M G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
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Abstract
The emergence of noninvasive imaging techniques for the definitive diagnosis and monitoring of cardiovascular disease has greatly altered cardiac imaging in the past 25 years. The practice of cardiac imaging in 1975 was centered on conventional radiography and angiography, but, in the past 2 decades, noninvasive techniques have substantially replaced catheterization and angiography. The reliance on echocardiography for the evaluation of many cardiac diseases had a profoundly negative influence on the role of the radiologist in cardiac imaging, since the exercise of this modality has been a nearly exclusive province of the cardiologist. However, in the past decade, magnetic resonance imaging has been gradually assuming more importance in cardiovascular diagnosis; with this increase in importance, the role of the radiologist has been reactivated. In 1975, fellowship training in cardiac imaging was frequently combined with training in angiography. Now, training may be more effective by combining cardiac and pulmonary imaging in a thoracic imaging fellowship, but cross-training with an associated subspeciality will be influenced by priorities and personnel in various departments.
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Affiliation(s)
- C B Higgins
- Department of Radiology, University of California, San Francisco, Medical Center, 505 Parnassus Ave, Box 0628, Suite L308, San Francisco, CA 94143-0628, USA.
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