1
|
Multimodality imaging in delineation of complex sinus venosus defects and treatment outcomes over the last decade. Cardiol Young 2022; 32:1112-1120. [PMID: 34521491 DOI: 10.1017/s1047951121003851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Diagnosis of sinus venosus defects, not infrequently associated with complex anomalous pulmonary venous drainage, may be delayed requiring multimodality imaging. METHODS Retrospective review of all patients from February 2008 to January 2019. RESULTS Thirty-seven children were diagnosed at a median age of 4.2 years (range 0.5-15.5 years). In 32 of 37 (86%) patients, diagnosis was achieved on transthoracic echocardiography, but five patients (14%) had complex variants (four had high insertion of anomalous vein into the superior caval vein and three had multiple anomalous veins draining to different sites, two of whom had drainage of one vein into the high superior caval vein). In these five patients, the final diagnosis was achieved by multimodality imaging and intra-operative findings. The median age at surgery was 5.2 years (range 1.6-15.8 years). Thirty-one patients underwent double patch repair, four patients a Warden repair, and two patients a single-patch repair. Of the four Warden repairs, two patients had a high insertion of right-sided anomalous pulmonary vein into the superior caval vein, one patient had bilateral superior caval veins, and one patient had right lower pulmonary vein insertion into the right atrium/superior caval vein junction. There was no post-operative mortality, reoperation, residual shunt or pulmonary venous obstruction. One patient developed superior caval vein obstruction and one patient developed atrial flutter. CONCLUSION Complementary cardiac imaging modalities improve diagnosis of complex sinus venosus defects associated with a wide variation in the pattern of anomalous pulmonary venous connection. Nonetheless, surgical treatment is associated with excellent outcomes.
Collapse
|
2
|
Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the use of cardiovascular magnetic resonance in pediatric congenital and acquired heart disease : Endorsed by The American Heart Association. J Cardiovasc Magn Reson 2022; 24:37. [PMID: 35725473 PMCID: PMC9210755 DOI: 10.1186/s12968-022-00843-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of CMR in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of CMR in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
Collapse
Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA
| |
Collapse
|
3
|
Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the Use of Cardiac Magnetic Resonance in Pediatric Congenital and Acquired Heart Disease: Endorsed by The American Heart Association. Circ Cardiovasc Imaging 2022; 15:e014415. [PMID: 35727874 PMCID: PMC9213089 DOI: 10.1161/circimaging.122.014415] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cardiovascular magnetic resonance has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of cardiovascular magnetic resonance in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of cardiovascular magnetic resonance in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
Collapse
Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, (M.A.F.).,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, (M.A.F.)
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA, (S.A.)
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA, (C.B.)
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA, (L.B.)
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA, (T.C.)
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA, (T.J.)
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK, (V.M.)
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA, (M.T.)
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA (C.W.)
| |
Collapse
|
4
|
Qiu JK, Bamira D, Vainrib AF, Latson LA, Halpern DG, Chun A, Saric M. Multimodality Imaging of Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis in Adults. CASE 2022; 6:107-113. [PMID: 35602989 PMCID: PMC9120852 DOI: 10.1016/j.case.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
SVASD should be suspected in cases of unexplained RV volume overload. Direct visualization of SVASD with TTE is difficult in adults compared with children. TEE is helpful for diagnosing SVASD and associated pulmonary venous abnormalities. Multimodal imaging techniques offer incremental value in the workup of SVASD.
Collapse
|
5
|
Brida M, Chessa M, Celermajer D, Li W, Geva T, Khairy P, Griselli M, Baumgartner H, Gatzoulis MA. Atrial septal defect in adulthood: a new paradigm for congenital heart disease. Eur Heart J 2021; 43:2660-2671. [PMID: 34535989 DOI: 10.1093/eurheartj/ehab646] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/09/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Atrial septal defects (ASDs) represent the most common congenital heart defect diagnosed in adulthood. Although considered a simple defect, challenges in optimal diagnostic and treatment options still exist due to great heterogeneity in terms of anatomy and time-related complications primarily arrhythmias, thromboembolism, right heart failure and, in a subset of patients, pulmonary arterial hypertension (PAH). Atrial septal defects call for tertiary expertise where all options may be considered, namely catheter vs. surgical closure, consideration of pre-closure ablation for patients with atrial tachycardia and suitability for closure or/and targeted therapy for patients with PAH. This review serves to update the clinician on the latest evidence, the nuances of optimal diagnostics, treatment options, and long-term follow-up care for patients with an ASD.
Collapse
Affiliation(s)
- Margarita Brida
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK.,Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre Zagreb, Kispaticeva ul. 12, Zagreb 10000, Croatia.,Department of Medical Rehabilitation, Medical Faculty, University of Rijeka, Ul. Braće Branchetta 20/1, Rijeka 51000, Croatia
| | - Massimo Chessa
- ACHD Unit - Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, Piazza Edmondo Malan, 2, Milan 20097, Italy.,UniSR - Vita Salute San Raffaele University, Via Olgettina, 58, Milan 20132, Italy
| | - David Celermajer
- Heart Research Institute, University of Sydney, Camperdown, NSW 2050, Australia
| | - Wei Li
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.,Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
| | - Paul Khairy
- Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Massimo Griselli
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - Helmut Baumgartner
- Department of Cardiology III: Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster 48149, Germany
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| |
Collapse
|
6
|
Relan J, Gupta SK, Rajagopal R, Ramakrishnan S, Gulati GS, Kothari SS, Saxena A, Sharma S, Rajashekar P, Anderson RH. Clarifying the anatomy of the superior sinus venosus defect. Heart 2021; 108:689-694. [PMID: 34417206 DOI: 10.1136/heartjnl-2021-319334] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/03/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We sought to clarify the variations in the anatomy of the superior cavoatrial junction and anomalously connected pulmonary veins in patients with superior sinus venosus defects using computed tomographic (CT) angiography. METHODS CT angiograms of 96 consecutive patients known to have superior sinus venosus defects were analysed. RESULTS The median age of the patients was 34.5 years. In seven (7%) patients, the defect showed significant caudal extension, having a supero-inferior dimension greater than 25 mm. All patients had anomalous connection of the right superior pulmonary vein. The right middle and right inferior pulmonary vein were also connected anomalously in 88 (92%) and 17 (18%) patients, respectively. Anomalous connection of the right inferior pulmonary vein was more common in those with significant caudal extension of the defect (57% vs 15%, p=0.005). Among anomalously connected pulmonary veins, the right superior, middle, and inferior pulmonary veins were committed to the left atrium in 6, 17, and 11 patients, respectively. The superior caval vein over-rode the interatrial septum in 67 (70%) patients, with greater than 50% over-ride in 3 patients. CONCLUSION Anomalous connection of the right-sided pulmonary veins is universal, but is not limited to the right upper lobe. Not all individuals have over-riding of superior caval vein. In a minority of patients, the defect has significant caudal extension, and anomalously connected pulmonary veins are committed to the left atrium. These findings have significant clinical and therapeutic implications.
Collapse
Affiliation(s)
- Jay Relan
- Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rengarajan Rajagopal
- Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | | | - Gurpreet Singh Gulati
- Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjiv Sharma
- Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Palleti Rajashekar
- Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Robert H Anderson
- Biosciences Institute, University of Newcastle, Newcastle-upon Tyne, UK
| |
Collapse
|
7
|
Emrich T, Bordonaro V, Schoepf UJ, Petrescu A, Young G, Halfmann M, Schoeler T, Decker J, Abidoye I, Emrich AL, Kreitner KF, Schmidt KH, Varga-Szemes A, Secinaro A. Right/Left Ventricular Blood Pool T2 Ratio as an Innovative Cardiac MRI Screening Tool for the Identification of Left-to-Right Shunts in Patients With Right Ventricular Disease. J Magn Reson Imaging 2021; 55:1452-1458. [PMID: 34374157 DOI: 10.1002/jmri.27881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Left-to-right (L-R) shunts are characterized by a pathological connection between high- and low-pressure systems, leading to a mixing of oxygen-rich blood with low oxygenated blood. They are typically diagnosed by phase-contrast cardiac magnetic resonance imaging (MRI) which requires extensive planning. T2 is sensitive to blood oxygenation and may be able to detect oxygenation differences between the left (LV) and right ventricles (RV) caused by L-R shunts. PURPOSE To test the feasibility of routine T2 mapping to detect L-R shunts. STUDY TYPE Retrospective. POPULATION Patients with known L-R shunts (N = 27), patients with RV disease without L-R shunts (N = 21), and healthy volunteers (HV; N = 52). FIELD STRENGTH/SEQUENCE 1.5 and 3 T/balanced steady-state free-precession (bSSFP) sequence (cine imaging), T2-prepared bSSFP sequence (T2 mapping), and velocity sensitized gradient echo sequence (phase-contrast MRI). ASSESSMENT Aortic (Qs) and pulmonary (Qp) flow was measured by phase-contrast imaging, and the Qp/Qs ratio was calculated as a measure of shunt severity. T2 maps were used to measure T2 in the RV and LV and the RV/LV T2 ratio was calculated. Cine imaging was used to calculate RV end-diastolic volume index (RV-EDVi). STATISTICAL TESTS Wilcoxon test, paired t-tests, Spearmen correlation coefficient, receiver operating curve (ROC) analysis. Significance level P < 0.05. RESULTS The Qp/Qs and T2 ratios in L-R shunt patients (1.84 ± 0.84 and 0.89 ± 0.07) were significantly higher compared to those in patients with RV disease (1.01 ± 0.03 and 0.72 ± 0.10) and in HV (1.04 ± 0.04 and 0.71 ± 0.09). A T2 ratio of >0.78 showed a sensitivity, specificity, and negative predictive value of 100%, 73.9%, and 100%, respectively, for the detection of L-R shunts. The T2 ratio was strongly correlated with the severity of the shunt (r = 0.83). DATA CONCLUSION RV/LV T2 ratio is an imaging biomarker that may be able to detect or rule-out L-R shunts. Such a diagnostic tool may prevent unnecessary phase-contrast acquisitions in cases with RV dilatation of unknown etiology. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.,Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Veronica Bordonaro
- Department of Imaging, Advanced Cardiovascular Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Aniela Petrescu
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Gabrielle Young
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Moritz Halfmann
- Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Theresia Schoeler
- Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Josua Decker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.,Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Ibukun Abidoye
- Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Radiology, Afe Babalola University Multisystem Hospital, Ado-Ekiti, Nigeria
| | - Anna Lena Emrich
- Department of Cardiothoracic and Vascular Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Karl-Friedrich Kreitner
- Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Kai Helge Schmidt
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Aurelio Secinaro
- Department of Imaging, Advanced Cardiovascular Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|
8
|
Abstract
Over the past decade, cardiovascular magnetic resonance (CMR) has become a mainstream noninvasive imaging tool for assessment of adult and pediatric patients with congenital heart disease. It provides comprehensive anatomic and hemodynamic information that echocardiography and catheterization alone do not provide. Extracardiac anatomy can be delineated with high spatial resolution, intracardiac anatomy can be imaged in multiple planes, and functional assessment can be made accurately and with high reproducibility. In patients with heart failure, CMR provides not only reference standard evaluation of ventricular volumes and function but also information about the possible causes of dysfunction.
Collapse
Affiliation(s)
- Vivek Muthurangu
- Institute of Cardiovascular Science, University College London, 30 Guilford Street, London WC1N 1EH, UK.
| |
Collapse
|
9
|
Leiner T, Bogaert J, Friedrich MG, Mohiaddin R, Muthurangu V, Myerson S, Powell AJ, Raman SV, Pennell DJ. SCMR Position Paper (2020) on clinical indications for cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2020; 22:76. [PMID: 33161900 PMCID: PMC7649060 DOI: 10.1186/s12968-020-00682-4] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 12/22/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) last published its comprehensive expert panel report of clinical indications for CMR in 2004. This new Consensus Panel report brings those indications up to date for 2020 and includes the very substantial increase in scanning techniques, clinical applicability and adoption of CMR worldwide. We have used a nearly identical grading system for indications as in 2004 to ensure comparability with the previous report but have added the presence of randomized controlled trials as evidence for level 1 indications. In addition to the text, tables of the consensus indication levels are included for rapid assimilation and illustrative figures of some key techniques are provided.
Collapse
Affiliation(s)
- Tim Leiner
- Department of Radiology, E.01.132, Utrecht University Medical Center, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Catholic University Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
| | - Raad Mohiaddin
- Department of Radiology, Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, South Kensington Campus, London, SW7 2AZ, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Science & Great Ormond Street Hospital for Children, UCL Institute of Cardiovascular, Great Ormond Street, London, WC1N 3JH, UK
| | - Saul Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA
| | - Dudley J Pennell
- Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- Imperial College, South Kensington Campus, London, SW7 2AZ, UK
| |
Collapse
|
10
|
Hsu HM, Chang YT, Su WJ, Chu JJ, Chang YS, Hwang MS. The morphogenesis and associated anomalous pulmonary venous drainage in sinus venosus defect. Pediatr Neonatol 2020; 61:92-99. [PMID: 31362863 DOI: 10.1016/j.pedneo.2019.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/11/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Sinus venosus defect (SVD) is an unusual type of interatrial communication (IAC) and is virtually always associated with partial anomalous pulmonary venous drainage (PAPVD) of the right pulmonary veins (RPV) to the superior vena cava (SVC) or right atrium (RA). However, its definite morphogenesis is still elusive, and diagnostic fallibility continues. METHODS We conducted a retrospective review of the echocardiograms, cardiac catheterization data, computed tomographic findings, and surgical notes of 44 children with surgery-confirmed isolated SVD from 1977 to 2016. We investigated the location of the IAC and its boundaries within the atrial septum and its anatomic relationship with the adjacent structures, including the anomalously draining RPV. We also tried to explore any possible associated abnormalities which might be implicated in the morphogenesis of SVD. RESULTS Two distinct types of IAC were defined. Forty patients had an IAC that was located posterosuperior to the intact fossa ovalis (superior type), and all were associated with PAPVD of the right upper and often the right middle pulmonary veins to the SVC. The remaining 4 patients had an IAC that was located posterior to the intact fossa ovalis (inferior type), and all were associated with PAPVD of all the RPV to the RA. Another consistently associated abnormality was a defect between the anomalously draining RPV posteriorly and the SVC or RA anteriorly. All these 44 patients underwent successful surgical baffling the associated PAPVD via the IAC into the left atrium. CONCLUSION A defect between the RPV posteriorly and the SVC or RA anteriorly will result in SVD, and an unusual type of IAC, and PAPVD of the RPV to the SVC or RA. The IAC is not a true atrial septal defect in the atrial septum proper, but it actually represents the left atrial orifice of the unroofed RPV.
Collapse
Affiliation(s)
- Hsin-Mao Hsu
- Department of Pediatric Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ya-Ting Chang
- Department of Pediatric Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Jen Su
- Department of Pediatric Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jaw-Ji Chu
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Sheng Chang
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mao-Sheng Hwang
- Department of Pediatric Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| |
Collapse
|
11
|
Azarine A, Garçon P, Stansal A, Canepa N, Angelopoulos G, Silvera S, Sidi D, Marteau V, Zins M. Four-dimensional Flow MRI: Principles and Cardiovascular Applications. Radiographics 2019; 39:632-648. [PMID: 30901284 DOI: 10.1148/rg.2019180091] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In-plane phase-contrast (PC) imaging is now a routine component of MRI of regional blood flow in the heart and great vessels. In-plane PC MRI provides a volumetric, isotropic, time-resolved cine sequence that enables three-directional velocity encoding, a technique known as four-dimensional (4D) flow MRI. Recent advances in 4D flow MRI have shortened imaging times, while progress in big-data processing has improved dataset pre- and postprocessing, thereby increasing the feasibility of 4D flow MRI in clinical practice. Important technical issues include selection of the optimal velocity-encoding sensitivity before acquisition and preprocessing of the raw data for phase-offset corrections. Four-dimensional flow MRI provides unprecedented capabilities for comprehensive analysis of complex blood flow patterns using new visualization tools such as streamlines and velocity vectors. Retrospective multiplanar navigation enables flexible retrospective flow quantification through any plane across the volume with good accuracy. Current flow parameters include forward flow, reverse flow, regurgitation fraction, and peak velocity. Four-dimensional flow MRI also supplies advanced flow parameters of use for research, such as wall shear stress. The vigorous burgeoning of new applications indicates that 4D flow MRI is becoming an important imaging modality for cardiovascular disorders. This article reviews the main technical issues of 4D flow MRI and the different parameters provided by it and describes the main applications in cardiovascular diseases, including congenital heart disease, cardiac valvular disease, aortic disease, and pulmonary hypertension. Online supplemental material is available for this article. ©RSNA, 2019 See discussion on this article by Ordovas .
Collapse
Affiliation(s)
- Arshid Azarine
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Philippe Garçon
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Audrey Stansal
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Nadia Canepa
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Giorgios Angelopoulos
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Stephane Silvera
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Daniel Sidi
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Véronique Marteau
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Marc Zins
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| |
Collapse
|
12
|
Abstract
We present a case of a 2-year-old girl who presented with respiratory distress and umbilical abscess, and was found to have an inferior sinus venosus defect, malposition of the atrial septum primum, absent septum secundum, and anomalous drainage of the right upper and lower pulmonary veins to the right atrium.
Collapse
|
13
|
Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI. Cardiol Young 2015; 25:819-38. [PMID: 25739865 DOI: 10.1017/s1047951115000025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.
Collapse
|
14
|
Valsangiacomo Buechel ER, Grosse-Wortmann L, Fratz S, Eichhorn J, Sarikouch S, Greil GF, Beerbaum P, Bucciarelli-Ducci C, Bonello B, Sieverding L, Schwitter J, Helbing WA, Galderisi M, Miller O, Sicari R, Rosa J, Thaulow E, Edvardsen T, Brockmeier K, Qureshi S, Stein J. Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI. Eur Heart J Cardiovasc Imaging 2015; 16:281-97. [PMID: 25712078 DOI: 10.1093/ehjci/jeu129] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.
Collapse
|
15
|
Abstract
Atrial septal defects are the third most common type of congenital heart disease. Included in this group of malformations are several types of atrial communications that allow shunting of blood between the systemic and the pulmonary circulations. Most children with isolated atrial septal defects are free of symptoms, but the rates of exercise intolerance, atrial tachyarrhythmias, right ventricular dysfunction, and pulmonary hypertension increase with advancing age and life expectancy is reduced in adults with untreated defects. The risk of development of pulmonary vascular disease, a potentially lethal complication, is higher in female patients and in older adults with untreated defects. Surgical closure is safe and effective and when done before age 25 years is associated with normal life expectancy. Transcatheter closure offers a less invasive alternative for patients with a secundum defect who fulfil anatomical and size criteria. In this Seminar we review the causes, anatomy, pathophysiology, treatment, and outcomes of atrial septal defects in children and adult patients in whom this defect is the primary cardiac anomaly.
Collapse
Affiliation(s)
- Tal Geva
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Jose D Martins
- Department of Pediatric Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Rachel M Wald
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
16
|
Geva T. Is MRI the preferred method for evaluating right ventricular size and function in patients with congenital heart disease?: MRI is the preferred method for evaluating right ventricular size and function in patients with congenital heart disease. Circ Cardiovasc Imaging 2014; 7:190-7. [PMID: 24449548 DOI: 10.1161/circimaging.113.000553] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tal Geva
- Department of Cardiology, Boston Children's Hospital, Boston, MA; and Department of Pediatrics, Harvard Medical School, Boston, MA
| |
Collapse
|
17
|
Achenbach S, Barkhausen J, Beer M, Beerbaum P, Dill T, Eichhorn J, Fratz S, Gutberlet M, Hoffmann M, Huber A, Hunold P, Klein C, Krombach G, Kreitner KF, Kühne T, Lotz J, Maintz D, Marholdt H, Merkle N, Messroghli D, Miller S, Paetsch I, Radke P, Steen H, Thiele H, Sarikouch S, Fischbach R. Konsensusempfehlungen der DRG/DGK/DGPK zum Einsatz der Herzbildgebung mit Computertomographie und Magnetresonanztomographie. KARDIOLOGE 2012. [DOI: 10.1007/s12181-012-0417-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
18
|
Vyas HV, Greenberg SB, Krishnamurthy R. MR Imaging and CT Evaluation of Congenital Pulmonary Vein Abnormalities in Neonates and Infants. Radiographics 2012; 32:87-98. [DOI: 10.1148/rg.321105764] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
19
|
Kilner PJ. The role of cardiovascular magnetic resonance in adults with congenital heart disease. Prog Cardiovasc Dis 2011; 54:295-304. [PMID: 22014496 DOI: 10.1016/j.pcad.2011.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The comprehensive coverage and versatility of cardiovascular magnetic resonance (CMR), providing functional as well as anatomical information, make it an important facility in a center specializing in the care of adults with congenital heart disease. Imaging specialists using CMR to investigate acquired heart disease should also be able to recognize and evaluate previously unsuspected congenital malformations. Conditions that may present or be picked up during imaging in adulthood include atrial septal defect, anomalously connected pulmonary veins, double-chambered right ventricle, congenitally corrected transposition of the great arteries, aortic coarctation, and patent arterial duct. To realize its full potential and to avoid pitfalls, CMR of adults with congenital heart disease requires specific training and experience. Appropriate pathophysiological understanding is needed to evaluate cardiovascular function after surgery for tetralogy of Fallot, after transposition of the great arteries, and after Fontan operations. For these and other more complex cases, CMR should ideally be undertaken by specialists committed to long-term collaboration with the clinicians and surgeons managing the patients in a tertiary referral center.
Collapse
Affiliation(s)
- Philip J Kilner
- CMR Unit, Royal Brompton Hospital and Imperial College, London, UK.
| |
Collapse
|
20
|
Abstract
Transthoracic echocardiography is the first-line modality for cardiovascular imaging in adults with congenital heart disease (ACHD). The windows of access that are possible with transthoracic echocardiography are, however, rarely adequate for all regions of interest. The choice of further imaging depends on the clinical questions that remain to be addressed. The strengths of MRI include comprehensive access and coverage, providing imaging of all parts of the right ventricle, the pulmonary arteries, pulmonary veins and aorta. Cine images and velocity maps are acquired in specifically aligned planes, with stacks of cines or dynamic contrast angiography providing more comprehensive coverage. Tissues can be characterised if necessary, and MRI provides relatively accurate measurements of biventricular function and volume flow. These parameters are important in the assessment and follow-up of adults after repairs for tetralogy of Fallot or transposition of the great arteries and after Fontan operations. The superior spatial resolution and rapid acquisition of CT are invaluable in selected situations, including the visualisation of anomalous coronary or aortopulmonary collateral arteries, the assessment of luminal patency after stenting and imaging in patients with pacemakers. Ionising radiation is, however, a concern in younger patients who may need repeated investigation. Adults with relatively complex conditions should ideally be imaged in a specialist ACHD centre, where dedicated echocardiographic and cardiovascular MRI services are a necessary facility. General radiologists should be aware of the nature and pathophysiology of congenital heart disease, and should be alert for previously undiagnosed cases presenting in adulthood, including cases of atrial septal defect, aortic coarctation, patent ductus arteriosus, double-chambered right ventricle and congenitally corrected transposition.
Collapse
Affiliation(s)
- P J Kilner
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.
| |
Collapse
|
21
|
Outcomes of inferior sinus venosus defect repair. J Thorac Cardiovasc Surg 2011; 142:517-22. [DOI: 10.1016/j.jtcvs.2011.01.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 11/25/2010] [Accepted: 01/19/2011] [Indexed: 11/20/2022]
|
22
|
Prompona M, Muehling O, Naebauer M, Schoenberg SO, Reiser M, Huber A. MRI for detection of anomalous pulmonary venous drainage in patients with sinus venosus atrial septal defects. Int J Cardiovasc Imaging 2010; 27:403-12. [PMID: 20686854 DOI: 10.1007/s10554-010-9675-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 07/24/2010] [Indexed: 11/27/2022]
Affiliation(s)
- Maria Prompona
- Institute of Clinical Radiology, Campus Grosshadern, University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
| | | | | | | | | | | |
Collapse
|
23
|
Gulati GS, Hoey ETD, Gopalan D, Agrawal BSK, Screaton NJ. Sinus venosus atrial septal defect in adults: utility of cardiovascular MRI in resolving this diagnostic dilemma. Heart Lung Circ 2010; 19:615-9. [PMID: 20655279 DOI: 10.1016/j.hlc.2010.06.666] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 05/27/2010] [Accepted: 06/07/2010] [Indexed: 12/01/2022]
Abstract
Sinus venosus atrial septal defect (SV-ASD) can be a challenging diagnostic problem. It can present with non-specific signs and symptoms and, on imaging, can mimic other causes of right heart dilatation. Transthoracic echocardiography using standard scan planes may be limited, due to the defect and any associated anomalous pulmonary venous drainage lying outside the confines of the fossa ovalis. At our institution, we use cardiovascular magnetic resonance imaging (CMRI) as a problem-solving tool in these patients. In this article, we discuss the utility of CMRI in establishing the diagnosis by presenting our recent experience and illustrating it with sample cases. We wish to highlight the problems relating to making a diagnosis of SV-ASD in adult patients, and how CMRI has contributed to overcoming these in our practice.
Collapse
|
24
|
Kilner PJ, Geva T, Kaemmerer H, Trindade PT, Schwitter J, Webb GD. Recommendations for cardiovascular magnetic resonance in adults with congenital heart disease from the respective working groups of the European Society of Cardiology. Eur Heart J 2010; 31:794-805. [PMID: 20067914 PMCID: PMC2848324 DOI: 10.1093/eurheartj/ehp586] [Citation(s) in RCA: 280] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 11/09/2009] [Accepted: 12/07/2009] [Indexed: 11/12/2022] Open
Abstract
This paper aims to provide information and explanations regarding the clinically relevant options, strengths, and limitations of cardiovascular magnetic resonance (CMR) in relation to adults with congenital heart disease (CHD). Cardiovascular magnetic resonance can provide assessments of anatomical connections, biventricular function, myocardial viability, measurements of flow, angiography, and more, without ionizing radiation. It should be regarded as a necessary facility in a centre specializing in the care of adults with CHD. Also, those using CMR to investigate acquired heart disease should be able to recognize and evaluate previously unsuspected CHD such as septal defects, anomalously connected pulmonary veins, or double-chambered right ventricle. To realize its full potential and to avoid pitfalls, however, CMR of CHD requires training and experience. Appropriate pathophysiological understanding is needed to evaluate cardiovascular function after surgery for tetralogy of Fallot, transposition of the great arteries, and after Fontan operations. For these and other complex CHD, CMR should be undertaken by specialists committed to long-term collaboration with the clinicians and surgeons managing the patients. We provide a table of CMR acquisition protocols in relation to CHD categories as a guide towards appropriate use of this uniquely versatile imaging modality.
Collapse
|
25
|
Crystal MA, Al Najashi K, Williams WG, Redington AN, Anderson RH. Inferior sinus venosus defect: Echocardiographic diagnosis and surgical approach. J Thorac Cardiovasc Surg 2009; 137:1349-55. [DOI: 10.1016/j.jtcvs.2008.12.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 11/05/2008] [Accepted: 12/19/2008] [Indexed: 10/20/2022]
|
26
|
Riesenkampff EMC, Schmitt B, Schnackenburg B, Huebler M, Alexi-Meskishvili V, Hetzer R, Berger F, Kuehne T. Partial anomalous pulmonary venous drainage in young pediatric patients: the role of magnetic resonance imaging. Pediatr Cardiol 2009; 30:458-64. [PMID: 19184180 DOI: 10.1007/s00246-008-9367-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 12/22/2008] [Indexed: 11/25/2022]
Abstract
Studies of larger patient groups for systematic assessment of the anatomical accuracy of magnetic resonance imaging (MRI) for partial anomalous pulmonary venous drainage (PAPVD) have been performed so far only in adults. This study was undertaken to evaluate whether MRI can precisely depict pulmonary venous anatomy in infants and young children. Data on 26 children under 10 years old that underwent MRI over the past 2 years for suspected PAPVD were assessed. The MRI protocol included shunt quantification by velocity-encoded cine as well as morphological and functional assessment by multislice multiphase and contrast-enhanced MR techniques. MRI was performed in the compliant patient in breath-hold (n = 8; age range, 4.6-9.5 years) and in the noncompliant patient in conscious-sedation free breathing (n = 18; age range, 0.4 to 7.5 years). In 22 patients, PAPVD was diagnosed with MRI and confirmed during surgery. In four patients with large atrial septal defects not accessible to percutaneous closure, normal pulmonary venous return was demonstrated by MRI and confirmed during surgery. MRI under conscious sedation accurately specifies the anatomy of pulmonary veins in infants and small children. Therefore, we suggest performing MRI in patients with inconclusive transthoracic echocardiographic results in the preoperative assessment of PAPVD.
Collapse
|
27
|
Cardiac MRI and Pulmonary MR Angiography of Sinus Venosus Defect and Partial Anomalous Pulmonary Venous Connection in Cause of Right Undiagnosed Ventricular Enlargement. AJR Am J Roentgenol 2009; 192:259-66. [PMID: 19098208 DOI: 10.2214/ajr.07.3430] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
28
|
Atypical atrial septal defects in children: noninvasive evaluation by cardiac MRI. Pediatr Radiol 2008; 38:1188-94. [PMID: 18787816 DOI: 10.1007/s00247-008-0977-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 05/21/2008] [Accepted: 06/22/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Atypical left-to-right shunts at the level of the atrium in children such as sinus venosus atrial septal defects (ASDs) and partial anomalous pulmonary venous return (PAPVR) may be difficult to assess by transthoracic or transoesophageal echocardiography. Free-breathing cardiac MRI may be a powerful alternative. OBJECTIVE To assess the value of free-breathing cardiac MRI in the delineation of atypical ASDs in children. MATERIALS AND METHODS A total of 82 children (mean age 5.9 years, range 1.1-15.7 years) with suspected ASD and inconclusive transthoracic echocardiography underwent cardiac MRI under free-breathing, mostly sedated conditions. Phase-contrast MRI was used for defect visualization and shunt quantification, and multiphase inflow MR angiography for delineation of pulmonary/systemic venous connections. RESULTS Of the 82 patients, 34 (41%) were diagnosed with atypical shunt lesions at the level of the atrium and 48 (59%) with simple secundum ASDs. No false-negative or false-positive findings were reported by MRI compared to cardiac catheterization and intraoperative findings. Superior sinus venosus ASD with partial anomalous PAPVR was present in 10 of the 82 children (12.2%), whereas 2 (2.4%) had a large posterior-inferior defect, 5 (6.1%) had isolated PAPVR, and 17 (20.7%) had multiple ASDs and/or associated vascular anomalies. Q(p)/Q(s) by phase-contrast MRI agreed well with oximetry values (mean difference 3%, limits of agreement +/-21-25%; Bland/Altman analysis). CONCLUSION Free-breathing cardiac MRI under sedation allows reliable identification of atypical left-to-right shunt defects at the level of the atrium in children in whom transcatheter ASD closure is unsuitable, including delineation of pulmonary or systemic venous anomalies and shunt quantification.
Collapse
|
29
|
|