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Wielandner A, Mlczoch E, Prayer D, Berger-Kulemann V. Potential of magnetic resonance for imaging the fetal heart. Semin Fetal Neonatal Med 2013; 18:286-97. [PMID: 23742821 DOI: 10.1016/j.siny.2013.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Significant congenital heart disease (sCHD) affects 3.6 per 1000 births, and is often associated with extracardiac and chromosomal anomalies. Although early mortality has been substantially reduced and the rate of long-term survival has improved, sCHD is, after preterm birth, the second most frequent cause of neonatal infant death. The prenatal detection of cardiac and vascular abnormalities enables optimal parental counselling and perinatal management. Echocardiography (ECG) is the first-line examination and gold standard by which cardiac malformations are defined. However, adequate examination by an experienced healthcare provider with modern technical imaging equipment is required. In addition, maternal factors and the gestational age may lower the image quality. Fetal magnetic resonance imaging (MRI) has been implemented over the last several years and is already used in the clinical routine as a second-line approach to assess fetal abnormalities. MRI of the fetal heart is still not routinely performed. Nevertheless, fetal cardiac MRI has the potential to complement ultrasound in detecting cardiovascular malformations and extracardiac lesions. The present work reviews the potential of MRI to delineate the anatomy and pathologies of the fetal heart. This work also deals with the limitations and continuing developments designed to overcome the current problems in cardiac imaging, including fast fetal heart rates, the lack of ECG-gating, and the presence of fetal movements.
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Affiliation(s)
- Alice Wielandner
- Department of Radiology, Medical University of Vienna, AKH, Vienna, Austria
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Jain R, Petrillo-Albarano T, Parks WJ, Linzer JF, Stockwell JA. Efficacy and safety of deep sedation by non-anesthesiologists for cardiac MRI in children. Pediatr Radiol 2013. [PMID: 23184069 DOI: 10.1007/s00247-012-2566-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac MRI has become widespread to characterize cardiac lesions in children. No study has examined the role of deep sedation performed by non-anesthesiologists for this investigation. OBJECTIVE We hypothesized that deep sedation provided by non-anesthesiologists can be provided with a similar safety and efficacy profile to general anesthesia provided by anesthesiologists. MATERIALS AND METHODS This is a retrospective chart review of children who underwent cardiac MRI over a 5-year period. The following data were collected from the medical records: demographic data, cardiac lesion, American Society of Anesthesiologists (ASA) physical status, sedation type, provider, medications, sedation duration and adverse events or interventions. Image and sedation adequacy were recorded. RESULTS Of 1,465 studies identified, 1,197 met inclusion criteria; 43 studies (3.6%) used general anesthesia, 506 (42.3%) had deep sedation and eight (0.7%) required anxiolysis only. The remaining 640 studies (53.5%) were performed without sedation. There were two complications in the general anesthesia group (4.7%) versus 17 in the deep sedation group (3.4%). Sedation was considered inadequate in 22 of the 506 deep sedation patients (4.3%). Adequate images were obtained in 95.3% of general anesthesia patients versus 86.6% of deep sedation patients. CONCLUSION There was no difference in the incidence of adverse events or cardiac MRI image adequacy for children receiving general anesthesia by anesthesiologists versus deep sedation by non-anesthesiologists. In summary, this study demonstrates that an appropriately trained sedation provider can provide deep sedation for cardiac MRI without the need for general anesthesia in selected cases.
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Affiliation(s)
- Rini Jain
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
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Ait-Ali L, De Marchi D, Lombardi M, Scebba L, Picano E, Murzi B, Festa P. The role of cardiovascular magnetic resonance in candidates for Fontan operation: proposal of a new algorithm. J Cardiovasc Magn Reson 2011; 13:69. [PMID: 22077996 PMCID: PMC3260224 DOI: 10.1186/1532-429x-13-69] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 11/11/2011] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND To propose a new diagnostic algorithm for candidates for Fontan and identify those who can skip cardiac catheterization (CC). METHODS Forty-four candidates for Fontan (median age 4.8 years, range: 2-29 years) were prospectively evaluated by trans-thoracic echocardiography (TTE), Cardiovascular magnetic resonance (CMR) and CC. Before CC, according to clinical, echo and CMR findings, patients were divided in two groups: Group I comprised 18 patients deemed suitable for Fontan without requiring CC; group II comprised 26 patients indicated for CC either in order to detect more details, or for interventional procedures. RESULTS In Group I ("CC not required") no unexpected new information affecting surgical planning was provided by CC. Conversely, in Group II new information was provided by CC in three patients (0 vs 11.5%, p = 0.35) and in six an interventional procedure was performed. During CC, minor complications occurred in one patient from Group I and in three from Group II (6 vs 14%, p = 0.7). Radiation Dose-Area product was similar in the two groups (Median 20 Gycm(2), range: 5-40 vs 26.5 Gycm(2), range: 9-270 p = 0.37). All 18 Group I patients and 19 Group II patients underwent a total cavo-pulmonary anastomosis; in the remaining seven group II patients, four were excluded from Fontan; two are awaiting Fontan; one refused the intervention. CONCLUSION In this paper we propose a new diagnostic algorithm in a pre-Fontan setting. An accurate non-invasive evaluation comprising TTE and CMR could select patients who can skip CC.
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Affiliation(s)
- Lamia Ait-Ali
- Institute of Clinical Physiology - National Research Council (CNR), Ospedale del cuore "G.Pasquinucci" Via Aurelia Sud 54100 Massa, Italy
- MRI Lab Fondazione G.Monasterio CNR-Regione Toscana Pisa Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Daniele De Marchi
- MRI Lab Fondazione G.Monasterio CNR-Regione Toscana Pisa Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Massimo Lombardi
- MRI Lab Fondazione G.Monasterio CNR-Regione Toscana Pisa Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Luigi Scebba
- Anesthesia departement, Ospedale del cuore "G.Pasquinucci" Fondazione G.Monasterio CNR-Regione Toscana Via Aurelia Sud 54100 Massa, Italy
| | - Eugenio Picano
- Institute of Clinical Physiology - National Research Council (CNR), Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Bruno Murzi
- Cardiac-surgery department. Ospedale del cuore "G.Pasquinucci" Fondazione G.Monasterio CNR-Regione Toscana Via Aurelia Sud 54100 Massa, Italy
| | - Pierluigi Festa
- MRI Lab Fondazione G.Monasterio CNR-Regione Toscana Pisa Via G. Moruzzi 1, 56124 Pisa, Italy
- Pediatric Cardiology department, Ospedale del cuore "G.Pasquinucci" Fondazione G.Monasterio CNR-Regione Toscana Via Aurelia Sud 54100 Massa, Italy
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Hage FG, Raslan S, Dean P, Nanda NC. Real Time Three-Dimensional Transthoracic Echocardiography in Congenital Heart Disease. Echocardiography 2011; 29:220-31. [DOI: 10.1111/j.1540-8175.2011.01555.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Fathala A. Quantitative lung perfusion scintigraphy in patients with congenital heart disease. Heart Views 2011; 11:109-14. [PMID: 21577378 PMCID: PMC3089824 DOI: 10.4103/1995-705x.76802] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The objectives of this article are to review different patterns and potential pitfalls of quantitative lung perfusion scintigraphy (LPS) in patients with congenital heart disease (CHD). The patterns of quantitative LPS in patients with CHD include normal symmetrical bilateral perfusion to both lungs, unilateral absent perfusion in one lung, unilateral decreased perfusion, and multiple segmental perfusion abnormalities that suggest pulmonary embolism. Knowledge of several potential pitfalls is very important to avoid false interpretations; common pitfalls are related to type of site of injection (upper versus lower extremities), right or left upper extremity in case of persistence of left superior vena cava and previous surgery. An important incidental finding that may prompt immediate attenuation is multiple segmental defect that suggests asymptomatic pulmonary embolism, which is relatively common in this population.
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Affiliation(s)
- Ahmed Fathala
- King Fasial Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Kawel N, Valsangiacomo-Buechel E, Hoop R, Kellenberger CJ. Preoperative evaluation of pulmonary artery morphology and pulmonary circulation in neonates with pulmonary atresia--usefulness of MR angiography in clinical routine. J Cardiovasc Magn Reson 2010; 12:52. [PMID: 20843357 PMCID: PMC2950013 DOI: 10.1186/1532-429x-12-52] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 09/15/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To explore the role of contrast-enhanced magnetic resonance angiography (CE-MRA) in clinical routine for evaluating neonates with pulmonary atresia (PA) and to describe their pulmonary artery morphology and blood supply.CE-MRA studies of 15 neonates with PA (12 female; median weight: 2900 g) were retrospectively evaluated by two radiologists in consensus. Each study was judged to be either diagnostic or non-diagnostic depending on the potential to evaluate pulmonary artery morphology and pulmonary blood supply. In those cases where surgery or conventional angiocardiography was performed results were compared. RESULTS CE-MRA was considered diagnostic in 87%. Pulmonary artery morphology was classified as "confluent with (n = 1) and without (n = 1) main pulmonary artery", "non-confluent" (n = 6) or "absent" (n = 7). Source of pulmonary blood supply was "a persistent arterial duct" (n = 12), "a direct" (n = 22) or "indirect (n = 9) aortopulmonary collateral artery (APCA)" or "an APCA from the ascending aorta" (n = 2). In no patient were there any additional findings at surgery or conventional angiocardiography which would have changed the therapeutic or surgical approach. CONCLUSIONS CE-MRA is a useful diagnostic tool for the preoperative evaluation of the morphology of pulmonary arteries and blood supply in neonates with PA. In most cases diagnostic cardiac catheterization can be avoided.
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Affiliation(s)
- Nadine Kawel
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Switzerland
- Department of Radiology, University Hospital Basel, Switzerland
| | | | - Ricarda Hoop
- Division of Paediatric Cardiology, University Children's Hospital Zurich, Switzerland
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Kumar A, Patton DJ, Friedrich MG. The emerging clinical role of cardiovascular magnetic resonance imaging. Can J Cardiol 2010; 26:313-22. [PMID: 20548977 DOI: 10.1016/s0828-282x(10)70396-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Starting as a research method little more than a decade ago, cardiovascular magnetic resonance (CMR) imaging has rapidly evolved to become a powerful diagnostic tool used in routine clinical cardiology. The contrast in CMR images is generated from protons in different chemical environments and, therefore, enables high-resolution imaging and specific tissue characterization in vivo, without the use of potentially harmful ionizing radiation.CMR imaging is used for the assessment of regional and global ventricular function, and to answer questions regarding anatomy. State-of-the-art CMR sequences allow for a wide range of tissue characterization approaches, including the identification and quantification of nonviable, edematous, inflamed, infiltrated or hypoperfused myocardium. These tissue changes are not only used to help identify the etiology of cardiomyopathies, but also allow for a better understanding of tissue pathology in vivo. CMR tissue characterization may also be used to stage a disease process; for example, elevated T2 signal is consistent with edema and helps differentiate acute from chronic myocardial injury, and the extent of myocardial fibrosis as imaged by contrast-enhanced CMR correlates with adverse patient outcome in ischemic and nonischemic cardiomyopathies.The current role of CMR imaging in clinical cardiology is reviewed, including coronary artery disease, congenital heart disease, nonischemic cardiomyopathies and valvular disease.
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Affiliation(s)
- Andreas Kumar
- Stephenson CMR Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Miller TA, Landes AB, Moran AM. Improved accuracy in flow mapping of congenital heart disease using stationary phantom technique. J Cardiovasc Magn Reson 2009; 11:52. [PMID: 20003318 PMCID: PMC2805649 DOI: 10.1186/1532-429x-11-52] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 12/10/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Flow mapping by cardiovascular magnetic resonance has become the gold standard for non-invasively defining cardiac output (CO), shunt flow and regurgitation. Previous reports have highlighted the presence of inherent errors in flow mapping that are improved with the use of a stationary phantom control. To our knowledge, these studies have only been performed in healthy volunteers. RESULTS We analyzed the variation in flow measurements made with and without stationary phantom correction in 31 patients with congenital heart disease. Variation in stroke volume (SV) measurements was seen in all vessels across all patient groups. The variation was largest when analyzing the right ventricular outflow tract (RVOT), with a range of absolute differences in SV from 0.2 to 70 ml and in CO from 0.02 to 4.8 L/min. In patients with repaired Tetrology of Fallot (ToF), the average ratio of pulmonary to systemic blood flow (Qp:Qs) was 1.18 without and 1.02 with phantom correction. Without performing phantom correction, 23% of the repaired ToF patients were classified as having a residual shunt as compared to 0% when flow mapping was performed with phantom correction. Similarly, in patients with known atrial level shunting (ASD/PAPVR) 20% of patients had no shunt when flow mapping was performed without phantom correction as compared to 0% with phantom correction. In patients with bicuspid aortic valves (BAV), the differences in the regurgitant fraction between measuring flow with and without phantom correction ranged from 0 to 30%, while the regurgitant fraction in the RVOT of ToF patients varied by as much as 31%. CONCLUSION The impact of inherent errors in CMR flow mapping should not be underestimated. While the variation across a population may not display a significant trend, for any individual patient it can be quite large. Failure to correct for such variation can lead to clinically significant misinterpretation of flow data. The use of the stationary phantom correction technique appears to improve accuracy both in normal patients as well as those with congenital heart disease.
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Affiliation(s)
- Thomas A Miller
- Department of Pediatrics, Maine Medical Center, 22 Bramhall St, Portland, ME, USA
| | - Andrew B Landes
- Department of Pediatrics, Maine Medical Center, 22 Bramhall St, Portland, ME, USA
- Department of Radiology, Maine Medical Center, 22 Bramhall St, Portland, ME, USA
| | - Adrian M Moran
- Department of Pediatrics, Maine Medical Center, 22 Bramhall St, Portland, ME, USA
- Department of Cardiology, Maine Medical Center, 22 Bramhall St, Portland, ME, USA
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Chan FP. MR and CT imaging of the pediatric patient with structural heart disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2009:99-105. [PMID: 19349022 DOI: 10.1053/j.pcsu.2009.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) are imaging modalities increasingly used in the diagnosis and management of structural heart disease. They are powerful imaging tools that have individual strengths and weaknesses. Rational choice between MRI and CT should be based on a sound understanding of these issues. Management guidelines that incorporate the use of MRI and CT are currently being developed, and their utilizations are expected to grow rapidly in the future.
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Affiliation(s)
- Frandics P Chan
- Department of Radiology, Stanford University Medical Center, Stanford, CA, USA.
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Chan FP. MR and CT Imaging of the Pediatric Patient with Structural Heart Disease. Semin Thorac Cardiovasc Surg 2008; 20:393-9. [DOI: 10.1053/j.semtcvs.2008.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2008] [Indexed: 11/11/2022]
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