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Maddali MM, Anderson RH, Al Maskari SN, Al Kindi F, Al Kindi HN. The Sinus Venosus Veno-Venous Bridge: Not a septal defect. Sultan Qaboos Univ Med J 2023; 23:5-9. [PMID: 38161764 PMCID: PMC10754305 DOI: 10.18295/squmj.12.2023.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/25/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
This review provides an update on the morphology of the sinus venosus defect. It was earlier believed that a 'common wall' separated the right pulmonary veins from the superior caval vein. In the sinus venosus defects, this wall was absent. Current evidence shows that the superior rim of the oval fossa, rather than forming a second septum or representing a common wall, is an infolding between the walls of the caval veins and the right pulmonary veins. The sinus venosus defect is caused by the anomalous connection of one or more pulmonary veins to a systemic vein. However, the pulmonary vein(s) retain their left atrial connections, leading to a veno-venous bridge that allows interatrial shunting outside the oval fossa. True atrial septal defects are located within the oval fossa or in the anteo-inferior buttress, while sinus venosus defects, ostium defects and coronary sinus defects are morphologically distinct from them.
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Affiliation(s)
| | - Robert H. Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom
| | | | | | - Hamood N. Al Kindi
- Cardiothoracic Surgery, National Heart Center, The Royal Hospital, Muscat, Oman
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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.
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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
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3
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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.
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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.)
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4
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Cardiovascular Computed Tomography in Pediatric Congenital Heart Disease: A State of the Art Review. J Cardiovasc Comput Tomogr 2022; 16:467-482. [DOI: 10.1016/j.jcct.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 01/04/2023]
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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.
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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
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6
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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.
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Affiliation(s)
- Vivek Muthurangu
- Institute of Cardiovascular Science, University College London, 30 Guilford Street, London WC1N 1EH, UK.
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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: 144] [Impact Index Per Article: 36.0] [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.
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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
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8
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Rat N, Muntean I, Opincariu D, Gozar L, Togănel R, Chițu M. Cardiovascular Imaging for Guiding Interventional Therapy in Structural Heart Diseases. Curr Med Imaging 2020; 16:111-122. [DOI: 10.2174/1573405614666180612081736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 10/05/2017] [Accepted: 03/19/2018] [Indexed: 11/22/2022]
Abstract
Development of interventional methods has revolutionized the treatment of structural
cardiac diseases. Given the complexity of structural interventions and the anatomical variability of
various structural defects, novel imaging techniques have been implemented in the current clinical
practice for guiding the interventional procedure and for selection of the device to be used. Three–
dimensional echocardiography is the most used imaging method that has improved the threedimensional
assessment of cardiac structures, and it has considerably reduced the cost of complications
derived from malalignment of interventional devices. Assessment of cardiac structures with
the use of angiography holds the advantage of providing images in real time, but it does not allow
an anatomical description. Transesophageal Echocardiography (TEE) and intracardiac ultrasonography
play major roles in guiding Atrial Septal Defect (ASD) or Patent Foramen Ovale (PFO)
closure and device follow-up, while TEE is the procedure of choice to assess the flow in the Left
Atrial Appendage (LAA) and the embolic risk associated with a decreased flow. On the other hand,
contrast CT and MRI have high specificity for providing a detailed description of structure, but
cannot assess the flow through the shunt or the valvular mobility. This review aims to present the
role of modern imaging techniques in pre-procedural assessment and intraprocedural guiding of
structural percutaneous interventions performed to close an ASD, a PFO, an LAA or a patent ductus
arteriosus.
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Affiliation(s)
- Nora Rat
- Department of Cardiology, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Iolanda Muntean
- Clinic of Pediatric Cardiology, Institute of Cardiovascular Disease and Transplantation, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Diana Opincariu
- Department of Cardiology, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Liliana Gozar
- Clinic of Pediatric Cardiology, Institute of Cardiovascular Disease and Transplantation, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Rodica Togănel
- Clinic of Pediatric Cardiology, Institute of Cardiovascular Disease and Transplantation, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Monica Chițu
- Department of Cardiology, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
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Subtraction of time-resolved magnetic resonance angiography images improves visualization of the pulmonary veins and left atrium in adults with congenital heart disease: a novel post-processing technique. Int J Cardiovasc Imaging 2019; 35:1339-1346. [DOI: 10.1007/s10554-019-01585-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/15/2019] [Indexed: 12/27/2022]
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10
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Computed Tomography Angiography and Magnetic Resonance Angiography of Congenital Anomalies of Pulmonary Veins. J Comput Assist Tomogr 2019; 43:399-405. [DOI: 10.1097/rct.0000000000000857] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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11
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Bonnichsen C, Ammash N. Choosing Between MRI and CT Imaging in the Adult with Congenital Heart Disease. Curr Cardiol Rep 2016; 18:45. [DOI: 10.1007/s11886-016-0717-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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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.
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13
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Sinus venosus atrial septal defect as a cause of palpitations and dyspnea in an adult: a diagnostic imaging challenge. Case Rep Med 2015; 2015:128462. [PMID: 25705227 PMCID: PMC4326212 DOI: 10.1155/2015/128462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/05/2015] [Accepted: 01/10/2015] [Indexed: 11/17/2022] Open
Abstract
Sinus venosus atrial septal defects (SV-ASD) have nonspecific clinical presentations and represent a diagnostic imaging challenge. Transthoracic echocardiography (TTE) remains the initial diagnostic imaging modality. However, detection rates have been as low as 12%. Transesophageal echocardiography (TEE) improves diagnostic accuracy though it may not detect commonly associated partial anomalous pulmonary venous return (PAPVR). Cardiac magnetic resonance (CMR) imaging provides a noninvasive, highly sensitive and specific imaging modality of SV-ASD. We describe a case of an adult male with exercise-induced, paroxysmal supraventricular tachycardia who presented with palpitations and dyspnea. Despite nondiagnostic imaging results on TTE, CMR proved to be instrumental in visualizing a hemodynamically significant SV-ASD with PAPVR that ultimately led to surgical correction.
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Szychta W, Cerin G, Popa BA, Felice A, Lanzillo G, Diena M, Opolski G. Atypical Abnormal Pulmonary Vein Drainage with Atrial Septal Defect: Surgical Treatment. Echocardiography 2015; 32:1040-3. [DOI: 10.1111/echo.12863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Wojciech Szychta
- 1 Chair and Department of Cardiology; Medical University of Warsaw; Warsaw Poland
| | - Gheorghe Cerin
- Cardiology Division in Cardiac Surgery Dept; Policlinic of Monza; San Gaudenzio Clinic; Novara Italy
| | - Bogdan Adrian Popa
- Cardiology Division in Cardiac Surgery Dept; Policlinic of Monza; San Gaudenzio Clinic; Novara Italy
| | - Armienti Felice
- Department of Radiology; Policlinic of Monza; San Gaudenzio Clinic; Novara Italy
| | - Guido Lanzillo
- Departments of Cardiac Surgery; Policlinic of Monza; San Gaudenzio Clinic; Novara Italy
| | - Marco Diena
- Departments of Cardiac Surgery; Policlinic of Monza; San Gaudenzio Clinic; Novara Italy
| | - Grzegorz Opolski
- 1 Chair and Department of Cardiology; Medical University of Warsaw; Warsaw Poland
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15
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Ganigara M, Tanous D, Celermajer D, Puranik R. The role of cardiac MRI in the diagnosis and management of sinus venosus atrial septal defect. Ann Pediatr Cardiol 2014; 7:160-2. [PMID: 24987269 PMCID: PMC4070212 DOI: 10.4103/0974-2069.132509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Sinus venosus atrial septal defects (SV-ASDs) are inter-atrial communications caused by a deficiency of the common wall between the superior or inferior vena cava and the right-sided pulmonary veins. The diagnosis can be challenging, especially in adults with delayed presentation. We present images that illustrate an example of the role of cardiac magnetic resonance imaging (CMRI) in the diagnosis and follow-up of a patient with SV-ASD.
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Affiliation(s)
- Madhusudan Ganigara
- Department of Cardiology, Faculty of Medicine, The University of Sydney, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - David Tanous
- Department of Cardiology, Faculty of Medicine, The University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia
| | - David Celermajer
- Department of Cardiology, Faculty of Medicine, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rajesh Puranik
- Department of Cardiology, Faculty of Medicine, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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16
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De SD, Maung Maung Aye W, Shankar S. Missed case of sinus venosus atrial septal defect post coronary artery bypass grafting. J Cardiothorac Surg 2014; 9:91. [PMID: 24884712 PMCID: PMC4046057 DOI: 10.1186/1749-8090-9-91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 05/06/2014] [Indexed: 11/10/2022] Open
Abstract
We report a case of a 41-year-old Indian man who initially underwent an emergency coronary artery bypass grafting surgery (CABG) after presenting with an anterolateral myocardial infarction. Post-operatively he developed progressively worsening symptoms of right heart failure with increasing abdominal distension and lower limb swelling. Clinically, the patient was in NYHA class 4 heart failure. He was admitted multiple times for the treatment of his heart failure, which was recalcitrant to diuretic therapy. He subsequently underwent an MRI scan, which revealed near transmural myocardial infarction involving mainly the left side of the heart. The right atrium and ventricle were grossly dilated, with moderate to severe right ventricular systolic dysfunction. A sinus venosus atrial septal defect with right-sided partial anomalous pulmonary venous drainange (PAPVD) was noted. He subsequently underwent surgery to repair the sinus venosus atrial septal defect (ASD) as well as re-route the PAPVD to the left atrium (LA). He was discharged on post-operative day 19 with oral diuretics. On follow-up at 1 month, the patient's symptoms had resolved and his clinical status corresponded to NYHA class 1–2.
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Affiliation(s)
- Sudeep Das De
- National University Health System, 1E Kent Ridge Road, Kent Ridge 119228, Singapore.
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17
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Gerrah R, Bardo DM, Reed RD, Sunstrom RE, Langley SM. Adjustment of the Surgical Plan in Repair of Congenital Heart Disease: The Power of Cross-sectional Imaging and Three-dimensional Visualization. CONGENIT HEART DIS 2013; 9:E31-6. [DOI: 10.1111/chd.12062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Rabin Gerrah
- Department of Surgery; Division of Pediatric Cardiac Surgery; Oregon Health and Science University; Doernbecher Children's Hospital; Portland Ore USA
| | - Dianna M.E. Bardo
- Department of Radiology; Oregon Health and Science University; Portland Ore USA
| | - Rich D. Reed
- Department of Surgery; Division of Pediatric Cardiac Surgery; Oregon Health and Science University; Doernbecher Children's Hospital; Portland Ore USA
| | - Rachel E. Sunstrom
- Department of Surgery; Division of Pediatric Cardiac Surgery; Oregon Health and Science University; Doernbecher Children's Hospital; Portland Ore USA
| | - Stephen M. Langley
- Department of Surgery; Division of Pediatric Cardiac Surgery; Oregon Health and Science University; Doernbecher Children's Hospital; Portland Ore USA
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Cardiovascular imaging 2011 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2012; 28:439-51. [PMID: 22476909 PMCID: PMC3326368 DOI: 10.1007/s10554-012-0040-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Nepomuceno R, Zeglinski M, Lerner J, Czarnecki W, Kirkpatrick IDC, Strzelczyk J, Jassal DS. Multimodality imaging of anomalous pulmonary veins. Cardiovasc Ultrasound 2011; 9:3. [PMID: 21288339 PMCID: PMC3038141 DOI: 10.1186/1476-7120-9-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 02/02/2011] [Indexed: 12/01/2022] Open
Abstract
Partial anomalous pulmonary venous connection (PAPVC) is an extremely rare congenital condition where one or more of the pulmonary veins are connected to the venous circulation. Although initially suspected with unexplained right ventricular enlargement on transthoracic echocardiography (TTE), cardiac MRI is able to delineate the anatomical variant. We present a case of a 65-year-old male diagnosed with left sided PAPVC using multimodality cardiac imaging.
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Affiliation(s)
- Roman Nepomuceno
- Institute of Cardiovascular Sciences, St. Boniface Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
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Huber A, Prompona M, Kozlik-Feldmann R, Mühling O, Rummeny E, Reiser M, Theisen D. [MRI for therapy planning in patients with atrial septum defects]. Radiologe 2011; 51:31-7. [PMID: 21243461 DOI: 10.1007/s00117-010-1998-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to determine the value of a combined magnetic resonance imaging (MRI) protocol including steady-state free precession (SSFP) imaging, phase-contrast measurements and contrast-enhanced MR angiography (CE-MRA) for presurgical or preinterventional diagnostic imaging in patients with suspected atrial septum defects. MATERIAL AND METHODS Out of 65 MRI studies of patients with suspected atrial septum defects, 56 patients were included in the study. The atrial septum defects were identified on cine images. Velocity encoded flow measurements were used to determine shunt volumes, which were compared with invasive oxymetry in 24 patients. Contrast-enhanced MRI was used to assess the thoracic vessels in order to detect vascular anomalies. The findings were compared with the intraoperative results. RESULTS A total of 24 patients with high shunt volumes were treated either surgically (16 patients) or interventionally (8 patients) and 32 patients with low shunt volumes did not require surgical or interventional treatment. The vascular anomaly, which in all cases was anomalous pulmonary venous return, was confirmed by the intraoperative findings. The type and location of atrial septal defects which required treatment, were confirmed intraoperatively or during the intervention. The results of shunt quantification by MRI showed a good correlation with the results of invasive oximetry (r=0.91, p <0.0001). CONCLUSION A combined MRI protocol including cine SSFP images, velocity-encoded flow measurements and CE-MRA is an accurate method for preoperative and preinterventional evaluation of atrial septum defects.
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Affiliation(s)
- A Huber
- Institut für Radiologie, Technische Universität München, München, Deutschland.
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