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Marchini F, Meossi S, Passarini G, Campo G, Pavasini R. Pulmonary Valve Stenosis: From Diagnosis to Current Management Techniques and Future Prospects. Vasc Health Risk Manag 2023; 19:379-390. [PMID: 37416511 PMCID: PMC10320808 DOI: 10.2147/vhrm.s380240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023] Open
Abstract
Pulmonary stenosis (PS) is mainly a congenital defect that accounts for 7-12% of congenital heart diseases (CHD). It can be isolated or, more frequently, associated with other congenital defects (25-30%) involving anomalies of the pulmonary vascular tree. For the diagnosis of PS an integrated approach with echocardiography, cardiac computed tomography and cardiac magnetic resonance (CMR) is of paramount importance for the planning of the interventional treatment. In recent years, transcatheter approaches for the treatment of PS have increased however, meaning surgery is a possible option for complicated cases with anatomy not suitable for percutaneous treatment. The present review aims to summarize current knowledge regarding diagnosis and treatment of PS.
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Affiliation(s)
- Federico Marchini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Sofia Meossi
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Giulia Passarini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
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Kollar SE, Udine ML, Mandell JG, Cross RR, Loke YH, Olivieri LJ. Impact of ferumoxytol vs gadolinium on 4D flow cardiovascular magnetic resonance measurements in small children with congenital heart disease. J Cardiovasc Magn Reson 2022; 24:58. [PMID: 36352454 PMCID: PMC9648014 DOI: 10.1186/s12968-022-00886-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/30/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) allows for time-resolved three-dimensional phase-contrast (4D Flow) analysis of congenital heart disease (CHD). Higher spatial resolution in small infants requires thinner slices, which can degrade the signal. Particularly in infants, the choice of contrast agent (ferumoxytol vs. gadolinium) may influence 4D Flow CMR accuracy. Thus, we investigated the accuracy of 4D Flow CMR measurements compared to gold standard 2D flow phase contrast (PC) measurements in ferumoxytol vs. gadolinium-enhanced CMR of small CHD patients with shunt lesions. METHODS This was a retrospective study consisting of CMR studies from complex CHD patients less than 20 kg who had ferumoxytol or gadolinium-enhanced 4D Flow and standard two-dimensional phase contrast (2D-PC) flow collected. 4D Flow clinical software (Arterys) was used to measure flow in great vessels, systemic veins, and pulmonary veins. 4D Flow accuracy was defined as percent difference or correlation against conventional measurements (2D-PC) from the same vessels. Subgroup analysis was performed on two-ventricular vs single-ventricular CHD, arterial vs venous flow, as well as low flows (defined as < 1.5 L/min) in 1V CHD. RESULTS Twenty-one ferumoxytol-enhanced and 23 gadolinium-enhanced CMR studies were included, with no difference in age (2.1 ± 1.6 vs. 2.3 ± 1.9 years, p = 0.70), patient body surface area (0.50 ± 0.2 vs. 0.52 ± 0.2 m2, p = 0.67), or vessel diameter (11.4 ± 5.2 vs. 12.4 ± 5.6 mm, p = 0.22). Ten CMR studies with single ventricular CHD were included. Overall, ferumoxytol-enhanced 4D flow CMR measurements demonstrated less percent difference to 2D-PC when compared to gadolinium-enhanced 4D Flow CMR studies. In subgroup analyses of arterial vs. venous flows (high velocity vs. low velocity) and low flow in single ventricle CHD, ferumoxytol-enhanced 4D Flow CMR measurements had stronger correlation to 2D-PC CMR. The contrast-to-noise ratio (CNR) in ferumoxytol-enhanced studies was higher than the CNR in gadolinium-enhanced studies. CONCLUSIONS Ferumoxytol-enhanced 4D Flow CMR has improved accuracy when compared to gadolinium 4D Flow CMR, particularly for infants with small vessels in CHD.
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Affiliation(s)
- Sarah E Kollar
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA.
| | - Michelle L Udine
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
| | - Jason G Mandell
- Division of Pediatric Cardiology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Russell R Cross
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
| | - Yue-Hin Loke
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
| | - Laura J Olivieri
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
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Multimodality Imaging of the Neglected Valve: Role of Echocardiography, Cardiac Magnetic Resonance and Cardiac Computed Tomography in Pulmonary Stenosis and Regurgitation. J Imaging 2022; 8:jimaging8100278. [PMID: 36286372 PMCID: PMC9605303 DOI: 10.3390/jimaging8100278] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/25/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
The pulmonary valve (PV) is the least imaged among the heart valves. However, pulmonary regurgitation (PR) and pulmonary stenosis (PS) can occur in a variety of patients ranging from fetuses, newborns (e.g., tetralogy of Fallot) to adults (e.g., endocarditis, carcinoid syndrome, complications of operated tetralogy of Fallot). Due to their complexity, PR and PS are studied using multimodality imaging to assess their mechanism, severity, and hemodynamic consequences. Multimodality imaging is crucial to plan the correct management and to follow up patients with pulmonary valvulopathy. Echocardiography remains the first line methodology to assess patients with PR and PS, but the information obtained with this technique are often integrated with cardiac magnetic resonance (CMR) and computed tomography (CT). This state-of-the-art review aims to provide an updated overview of the usefulness, strengths, and limits of multimodality imaging in patients with PR and PS.
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The Modern Surgical Approach to Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collateral Arteries. CHILDREN 2022; 9:children9040515. [PMID: 35455558 PMCID: PMC9030555 DOI: 10.3390/children9040515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/19/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022]
Abstract
Pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals is a complex congenital heart defect that includes a heterogeneous subgroup of patients. Variation in the sources of pulmonary blood flow contributes to the complexity of the lesion and the diversity of approaches to its management. Unifocalization and rehabilitation focus on mobilization of collateral arteries and growth of native pulmonary arteries, respectively, with the ultimate surgical goal of achieving separated systemic and pulmonary circulations with the lowest possible right ventricular pressure. Regardless of the strategy, outcomes have altered the natural history of the disease, with a complete repair rate of approximately 80% and low early and late mortality rates. Given this heterogeneity of pulmonary vasculature, a tailored approach should be adopted for each patient, using all diagnostic methods currently offered by technical developments.
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Curione D, Ciliberti P, Monti CB, Capra D, Bordonaro V, Ciancarella P, Santangelo TP, Napolitano C, Ferrara D, Perrone MA, Secchi F, Secinaro A. Compressed Sensing Cardiac Cine Imaging Compared with Standard Balanced Steady-State Free Precession Cine Imaging in a Pediatric Population. Radiol Cardiothorac Imaging 2022; 4:e210109. [PMID: 35506130 DOI: 10.1148/ryct.210109] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 03/21/2022] [Accepted: 03/29/2022] [Indexed: 11/11/2022]
Abstract
Purpose To compare real-time compressed sensing (CS) and standard balanced steady-state free precession (bSSFP) cardiac cine imaging in children. Materials and Methods Twenty children (mean age, 15 years ± 5 [SD], range, 7-21 years; 10 male participants) with biventricular congenital heart disease (n = 11) or cardiomyopathy (n = 9) were prospectively included. Examinations were performed with 1.5-T imagers by using both bSSFP and CS sequences in all participants. Quantification of ventricular volumes and function was performed for all images by two readers blinded to patient diagnosis and type of sequence. Values were correlated with phase-contrast flow measurements by one reader. Intra- and interreader agreement were analyzed. Results There were no significant differences between ventricular parameters measured on CS compared with those of bSSFP (P > .05) for reader 1. Only ejection fraction showed a significant difference (P = .02) for reader 2. Intrareader agreement was considerable for both sequences (bSSFP: mean difference range, +1 to -2.6; maximum CI, +7.9, -13; bias range, 0.1%-4.1%; intraclass correlation coefficient [ICC] range, 0.931-0.997. CS: mean difference range, +7.4 to -5.6; maximum CI, +37.2, -48.8; bias range, 0.5%-7.5%; ICC range, 0.717-0.997). Interreader agreement was acceptable but less robust, especially for CS (bSSFP: mean difference range, +2.6 to -5.6; maximum CI, +60.7, -65.3; bias range, 1.6%-6.2%; ICC range, 0.726-0.951. CS: mean difference range, +10.7 to -9.1; maximum CI, +87.5, -84.6; bias range, 1.1%-17.3%; ICC range, 0.509-0.849). The mean acquisition time was shorter for CS (20 seconds; range, 17-25 seconds) compared with that for bSSFP (160 seconds; range, 130-190 seconds) (P < .001). Conclusion CS cardiac cine imaging provided equivalent ventricular volume and function measurements with shorter acquisition times compared with those of bSSFP and may prove suitable for the pediatric population.Keywords: Compressed Sensing, Balanced Steady-State Free Precession, Cine Imaging, Cardiovascular MRI, Pediatrics, Cardiac, Heart, Cardiomyopathies, Congenital, Segmentation© RSNA, 2022.
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Affiliation(s)
- Davide Curione
- Advanced Cardiovascular Radiology Unit, Department of Radiology and Bioimaging (D. Curione, V.B., P. Ciancarella, T.P.S., C.N., A.S.), and Department of Pediatric Cardiology and Cardiac Surgery (P. Ciliberti, M.A.P.), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., D. Capra, F.S.); Department of Radiology, Santobono-Pausilipon Children's Hospital, Naples, Italy (D.F.); and Unit of Radiology, IRCCS Policlinco San Donato, San Donato Milanese, Italy (F.S.)
| | - Paolo Ciliberti
- Advanced Cardiovascular Radiology Unit, Department of Radiology and Bioimaging (D. Curione, V.B., P. Ciancarella, T.P.S., C.N., A.S.), and Department of Pediatric Cardiology and Cardiac Surgery (P. Ciliberti, M.A.P.), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., D. Capra, F.S.); Department of Radiology, Santobono-Pausilipon Children's Hospital, Naples, Italy (D.F.); and Unit of Radiology, IRCCS Policlinco San Donato, San Donato Milanese, Italy (F.S.)
| | - Caterina Beatrice Monti
- Advanced Cardiovascular Radiology Unit, Department of Radiology and Bioimaging (D. Curione, V.B., P. Ciancarella, T.P.S., C.N., A.S.), and Department of Pediatric Cardiology and Cardiac Surgery (P. Ciliberti, M.A.P.), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., D. Capra, F.S.); Department of Radiology, Santobono-Pausilipon Children's Hospital, Naples, Italy (D.F.); and Unit of Radiology, IRCCS Policlinco San Donato, San Donato Milanese, Italy (F.S.)
| | - Davide Capra
- Advanced Cardiovascular Radiology Unit, Department of Radiology and Bioimaging (D. Curione, V.B., P. Ciancarella, T.P.S., C.N., A.S.), and Department of Pediatric Cardiology and Cardiac Surgery (P. Ciliberti, M.A.P.), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., D. Capra, F.S.); Department of Radiology, Santobono-Pausilipon Children's Hospital, Naples, Italy (D.F.); and Unit of Radiology, IRCCS Policlinco San Donato, San Donato Milanese, Italy (F.S.)
| | - Veronica Bordonaro
- Advanced Cardiovascular Radiology Unit, Department of Radiology and Bioimaging (D. Curione, V.B., P. Ciancarella, T.P.S., C.N., A.S.), and Department of Pediatric Cardiology and Cardiac Surgery (P. Ciliberti, M.A.P.), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., D. Capra, F.S.); Department of Radiology, Santobono-Pausilipon Children's Hospital, Naples, Italy (D.F.); and Unit of Radiology, IRCCS Policlinco San Donato, San Donato Milanese, Italy (F.S.)
| | - Paolo Ciancarella
- Advanced Cardiovascular Radiology Unit, Department of Radiology and Bioimaging (D. Curione, V.B., P. Ciancarella, T.P.S., C.N., A.S.), and Department of Pediatric Cardiology and Cardiac Surgery (P. Ciliberti, M.A.P.), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., D. Capra, F.S.); Department of Radiology, Santobono-Pausilipon Children's Hospital, Naples, Italy (D.F.); and Unit of Radiology, IRCCS Policlinco San Donato, San Donato Milanese, Italy (F.S.)
| | - Teresa Pia Santangelo
- Advanced Cardiovascular Radiology Unit, Department of Radiology and Bioimaging (D. Curione, V.B., P. Ciancarella, T.P.S., C.N., A.S.), and Department of Pediatric Cardiology and Cardiac Surgery (P. Ciliberti, M.A.P.), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., D. Capra, F.S.); Department of Radiology, Santobono-Pausilipon Children's Hospital, Naples, Italy (D.F.); and Unit of Radiology, IRCCS Policlinco San Donato, San Donato Milanese, Italy (F.S.)
| | - Carmela Napolitano
- Advanced Cardiovascular Radiology Unit, Department of Radiology and Bioimaging (D. Curione, V.B., P. Ciancarella, T.P.S., C.N., A.S.), and Department of Pediatric Cardiology and Cardiac Surgery (P. Ciliberti, M.A.P.), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., D. Capra, F.S.); Department of Radiology, Santobono-Pausilipon Children's Hospital, Naples, Italy (D.F.); and Unit of Radiology, IRCCS Policlinco San Donato, San Donato Milanese, Italy (F.S.)
| | - Dolores Ferrara
- Advanced Cardiovascular Radiology Unit, Department of Radiology and Bioimaging (D. Curione, V.B., P. Ciancarella, T.P.S., C.N., A.S.), and Department of Pediatric Cardiology and Cardiac Surgery (P. Ciliberti, M.A.P.), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., D. Capra, F.S.); Department of Radiology, Santobono-Pausilipon Children's Hospital, Naples, Italy (D.F.); and Unit of Radiology, IRCCS Policlinco San Donato, San Donato Milanese, Italy (F.S.)
| | - Marco Alfonso Perrone
- Advanced Cardiovascular Radiology Unit, Department of Radiology and Bioimaging (D. Curione, V.B., P. Ciancarella, T.P.S., C.N., A.S.), and Department of Pediatric Cardiology and Cardiac Surgery (P. Ciliberti, M.A.P.), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., D. Capra, F.S.); Department of Radiology, Santobono-Pausilipon Children's Hospital, Naples, Italy (D.F.); and Unit of Radiology, IRCCS Policlinco San Donato, San Donato Milanese, Italy (F.S.)
| | - Francesco Secchi
- Advanced Cardiovascular Radiology Unit, Department of Radiology and Bioimaging (D. Curione, V.B., P. Ciancarella, T.P.S., C.N., A.S.), and Department of Pediatric Cardiology and Cardiac Surgery (P. Ciliberti, M.A.P.), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., D. Capra, F.S.); Department of Radiology, Santobono-Pausilipon Children's Hospital, Naples, Italy (D.F.); and Unit of Radiology, IRCCS Policlinco San Donato, San Donato Milanese, Italy (F.S.)
| | - Aurelio Secinaro
- Advanced Cardiovascular Radiology Unit, Department of Radiology and Bioimaging (D. Curione, V.B., P. Ciancarella, T.P.S., C.N., A.S.), and Department of Pediatric Cardiology and Cardiac Surgery (P. Ciliberti, M.A.P.), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., D. Capra, F.S.); Department of Radiology, Santobono-Pausilipon Children's Hospital, Naples, Italy (D.F.); and Unit of Radiology, IRCCS Policlinco San Donato, San Donato Milanese, Italy (F.S.)
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Abstract
A Fontan circulation requires a series of three-staged operations aimed to palliate patients with single-ventricle CHD. Currently, the most frequent technique is the extracardiac total cavopulmonary connection, an external conduit connecting the IVC and right pulmonary artery, bypassing the right side of the heart. Fontan candidates must meet strict criteria; they are assessed utilising both cardiac catheterisation and cardiac magnetic resonance. Postoperatively, treatment protocols prioritise antibiotic prophylaxis, diuretics, angiotensin-converting enzyme inhibitors, anticoagulation, and oxygen therapy with fluid restriction and a low-fat diet. These measures aim to reduce length of stay in the ICU and hospital by preventing acute complications such as infection, venous thromboembolism, low cardiac output, pleural effusion, and acute kidney injury. Late complications of a Fontan procedure include circulation failure, protein-losing enteropathy, plastic bronchitis, and Fontan-associated liver disease. The definitive management is cardiac transplantation, with promising innovations in selective embolisation of lymphatic vessels and Fontan-specific ventricular assist devices. Further research assessing current protocols in the perioperative management of Fontan patients would be beneficial for standardising current practice and improving outcomes.
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Pontone G, Di Cesare E, Castelletti S, De Cobelli F, De Lazzari M, Esposito A, Focardi M, Di Renzi P, Indolfi C, Lanzillo C, Lovato L, Maestrini V, Mercuro G, Natale L, Mantini C, Polizzi A, Rabbat M, Secchi F, Secinaro A, Aquaro GD, Barison A, Francone M. Appropriate use criteria for cardiovascular magnetic resonance imaging (CMR): SIC-SIRM position paper part 1 (ischemic and congenital heart diseases, cardio-oncology, cardiac masses and heart transplant). LA RADIOLOGIA MEDICA 2021; 126:365-379. [PMID: 33629237 PMCID: PMC7937599 DOI: 10.1007/s11547-020-01332-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/22/2020] [Indexed: 01/02/2023]
Abstract
Cardiac magnetic resonance (CMR) has emerged as new mainstream technique for the evaluation of patients with cardiac diseases, providing unique information to support clinical decision-making. This document has been developed by a joined group of experts of the Italian Society of Cardiology and Italian society of Radiology and aims to produce an updated consensus statement about the current state of technology and clinical applications of CMR. The writing committee consisted of members and experts of both societies who worked jointly to develop a more integrated approach in the field of cardiac radiology. Part 1 of the document will cover ischemic heart disease, congenital heart disease, cardio-oncology, cardiac masses and heart transplant.
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Affiliation(s)
| | - Ernesto Di Cesare
- Department of Life, Healt and Enviromental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Silvia Castelletti
- Center for the Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Francesco De Cobelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Manuel De Lazzari
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Antonio Esposito
- Center for the Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Marta Focardi
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Paolo Di Renzi
- U.O.C. Radiologia, Ospedale "San Giovanni Calibita" Fatebenefratelli - Isola Tiberina, Rome, Italy
| | - Ciro Indolfi
- Division of Cardiology, University Magna Graecia, Italy and Mediterranea Cardiocentro, Naples, Italy
| | | | - Luigi Lovato
- Cardiovascular Radiology Unit, Department of Imaging S.Orsola, Malpighi University Hospital, Bologna, Italy
| | - Viviana Maestrini
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luigi Natale
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology - Diagnostic Imaging Area, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Universita ` Cattolica del Sacro Cuore, Rome, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Aldo Polizzi
- Unit of Radiodiagnostics II, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Mark Rabbat
- Loyola University of Chicago, Chicago, USA
- Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit, Department of Imaging, Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy.
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Late gadolinium enhancement in patients with Tetralogy of Fallot: A systematic review. Eur J Radiol 2021; 136:109521. [PMID: 33450661 DOI: 10.1016/j.ejrad.2021.109521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/09/2020] [Accepted: 01/04/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this study is to review the literature concerning myocardial late gadolinium enhancement (LGE) with cardiac magnetic resonance in patients with Tetralogy of Fallot (ToF), with regards to its prevalence, characteristics and clinical relevance. METHODS We performed a systematic search, aiming to retrieve original articles that evaluated LGE in ToF, running a search string on MEDLINE and EMBASE in November 2019 and November 2020. Papers were then selected by two independent, blinded readers based on title and abstract, and then on full-text reading, and articles which did not include LGE evaluation were excluded. From each included paper two readers extracted descriptive data concerning technical parameters of LGE acquisition, LGE description and clinical significance. RESULTS 18 articles were eventually included in our review. The included studies observed that a higher amount of right ventricular LGE relates with higher right ventricular volumes, lower ejection fraction and a higher pulmonary regurgitant fraction, thus acting as a marker of progressive impairment of myocardial function. Moreover, LGE in ToF patients correlated with the onset of arrhythmias, and with serum biomarkers indicative of myocardial stress and fibrosis. CONCLUSIONS LGE could be used in the follow-up repaired ToF patients as its appraisal can provide information concerning cardiac dysfunction. Moreover, it may be ideal to aim towards a common framework for standardizing assessment and quantification of LGE in ToF patients.
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Bordonaro V, Ciancarella P, Ciliberti P, Curione D, Napolitano C, Santangelo TP, Natali GL, Rollo M, Guccione P, Pasquini L, Secinaro A. Dynamic contrast-enhanced magnetic resonance lymphangiography in pediatric patients with central lymphatic system disorders. LA RADIOLOGIA MEDICA 2021; 126:737-743. [PMID: 33394367 DOI: 10.1007/s11547-020-01309-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/15/2020] [Indexed: 11/28/2022]
Abstract
Central conducting lymphatics (CCLs) disorders represent a broad spectrum of clinical entities ranging from self-limiting traumatic leaks treated by conservative strategies, to complex lymphatic circulation abnormalities that are progressive and unresponsive to currently available treatments. Dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) performed by intranodal injection of gadolinium-based contrast material is a recently developed technique which allows a minimally invasive evaluation of the CCL abnormalities providing a dynamic assessment of lymph flow and its pathways. In our institution, DCMRL is performed after bilateral cannulation of inguinal lymph nodes, using a MR protocol which includes volumetric 3D T2-SPACE (sampling perfection with application-optimized contrasts using different flip-angle evolution) and free-breathing respiratory navigated sequence and TWIST (time-resolved angiography with Interleaved stochastic trajectories) MR angiography sequence, during intranodal injection of paramagnetic contrast medium. Although DCMRL applications in clinical practice are still improving, a minimally invasive assessment of lymphatic pathways is particularly important both in pediatric patients with primitive lymphatic system disorders and in children with complex congenital heart disease associated with CCL impairment.
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Affiliation(s)
- Veronica Bordonaro
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Paolo Ciancarella
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Ciliberti
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Davide Curione
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carmela Napolitano
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Gian Luigi Natali
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimo Rollo
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Guccione
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luciano Pasquini
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Aurelio Secinaro
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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10
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Ciancarella P, Ciliberti P, Santangelo TP, Secchi F, Stagnaro N, Secinaro A. Noninvasive imaging of congenital cardiovascular defects. Radiol Med 2020; 125:1167-1185. [PMID: 32955650 DOI: 10.1007/s11547-020-01284-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/03/2020] [Indexed: 12/19/2022]
Abstract
Advances in the treatment have drastically increased the survival rate of congenital heart disease (CHD) patients. Therefore, the prevalence of these patients is growing. Imaging plays a crucial role in the diagnosis and management of this population as a key component of patient care at all stages, especially in those patients who survived into adulthood. Over the last decades, noninvasive imaging techniques, such as cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT), progressively increased their clinical relevance, reaching stronger levels of accuracy and indications in the clinical surveillance of CHD. The current review highlights the main technical aspects and clinical applications of CMR and CCT in the setting of congenital cardiovascular abnormalities, aiming to address a state-of-the-art guidance to every physician and cardiac imager not routinely involved in the field.
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Affiliation(s)
- Paolo Ciancarella
- Department of Imaging, Advanced Cardiovascular Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Paolo Ciliberti
- Pediatric Cardiology and Pediatric Cardiac Surgery Department, Bambino Gesù Children's Hospital IRCSS, Rome, Italy
| | - Teresa Pia Santangelo
- Department of Imaging, Advanced Cardiovascular Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Francesco Secchi
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy
| | - Nicola Stagnaro
- Radiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Aurelio Secinaro
- Department of Imaging, Advanced Cardiovascular Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
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11
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Muscogiuri G, Suranyi P, Eid M, Varga-Szemes A, Griffith L, Pontone G, Schoepf UJ, De Cecco CN. Pediatric Cardiac MR Imaging:: Practical Preoperative Assessment. Magn Reson Imaging Clin N Am 2019; 27:243-262. [PMID: 30910096 DOI: 10.1016/j.mric.2019.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Prevalence of patients with congenital heart disease (CHD) is rapidly increasing due to continuous advancements in diagnostic techniques and medical or surgical treatment approaches. Along with cardiac computed tomography angiography, cardiac magnetic resonance (CMR) serves as a fundamental imaging modality for pre-surgical planning in patients with CHD, as CMR allows for the evaluation of cardiac and great vessel anatomy, biventricular function, flow dynamics, and tissue characterization. This information is essential for risk-assessment and optimal timing of surgical interventions. This article discusses the current role of pediatric cardiac MR imaging as a practical preoperative assessment tool in the pediatric population.
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Affiliation(s)
- Giuseppe Muscogiuri
- Centro Cardiologico Monzino, IRCCS, Via Centro Cardiologico Monzino, Via Carlo Parea, 4, 20138 Milano MI, Italy; Department of Clinical and Molecular Medicine, University of Rome "Sapienza", Rome, Italy
| | - Pal Suranyi
- Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Dr, MUSC, Charleston, SC 29401, USA
| | - Marwen Eid
- Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Dr, MUSC, Charleston, SC 29401, USA
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Dr, MUSC, Charleston, SC 29401, USA
| | - Lewis Griffith
- Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Dr, MUSC, Charleston, SC 29401, USA
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, Via Centro Cardiologico Monzino, Via Carlo Parea, 4, 20138 Milano MI, Italy
| | - Uwe Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Dr, MUSC, Charleston, SC 29401, USA
| | - Carlo N De Cecco
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, Emory Healthcare, Inc., 1364 Clifton Road Northeast, Atlanta, GA 30322, USA.
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12
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Apostolopoulou SC, Manginas A, Kelekis NL, Noutsias M. Cardiovascular imaging approach in pre and postoperative tetralogy of Fallot. BMC Cardiovasc Disord 2019; 19:7. [PMID: 30616556 PMCID: PMC6323806 DOI: 10.1186/s12872-018-0996-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/27/2018] [Indexed: 11/10/2022] Open
Abstract
Advances in the medical and surgical management of Tetralogy of Fallot have led to marked increase of the number and age of survivors. Imaging in patients with Tetralogy of Fallot plays a crucial role in the diagnosis and follow up, and essentially guides management and intervention in this entity. This study systematically reviews the imaging modalities used in patients with Tetralogy of Fallot in the evaluation of preoperative and postoperative anatomic and hemodynamic lesions, as well as disease progression in this diagnosis. Various invasive and noninvasive imaging modalities, most commonly echocardiography and cardiovascular magnetic resonance, computed tomography and angiocardiography provide the imaging information required for diagnosis, management and follow up in Tetralogy of Fallot. The choice of the appropriate imaging tool or their combination is guided by the clinical question, the patient's clinical condition and contraindications as well as the strengths and weaknesses of each imaging modality. Tetralogy of Fallot is the most common complex congenital heart disease with long term survivors that need close follow up and complicated management, including multiple surgical and transcatheter interventions. Knowledge of the role and protocols of imaging in Tetralogy of Fallot is extremely important for the clinical as well as the imaging physician in order to optimize patients' management and long-term prognosis.
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Affiliation(s)
- Sotiria C. Apostolopoulou
- Department of Pediatric Cardiology & Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, 356 Syngrou Ave, 176 74 Athens, GR Greece
| | - Athanassios Manginas
- Interventional Cardiology and Cardiology Department, Mediterraneo Hospital, Athens, Greece
| | - Nikolaos L. Kelekis
- 2nd Department of Radiology, General University Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120 Halle (Saale), Germany
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13
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14
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Utility of Cardiac Magnetic Resonance Imaging in the Management of Adult Congenital Heart Disease. J Thorac Imaging 2017. [DOI: 10.1097/rti.0000000000000280] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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