1
|
Grosse-Wortmann L, Wald R, Valverde I, Lsangiacomo-Buechel E, Ordovas K, Raimondi F, Babu-Narayan S, Krishnamurthy R, Yim D, Rathod RH. Society for Cardiovascular Magnetic Resonance Guidelines for Reporting Cardiovascular Magnetic Resonance Examinations in Patients with Congenital Heart Disease. J Cardiovasc Magn Reson 2024:101062. [PMID: 39053855 DOI: 10.1016/j.jocmr.2024.101062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/18/2024] [Indexed: 07/27/2024] Open
Affiliation(s)
- Lars Grosse-Wortmann
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, USA.
| | - Rachel Wald
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Israel Valverde
- The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Ontario, Canada
| | | | - Karen Ordovas
- University of Washington, Department of Radiology, Seattle, WA, USA
| | - Francesca Raimondi
- Department of Pediatric and Adult Congenital Heart Diseases, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Sonya Babu-Narayan
- Royal Brompton Hospital, Department of Adult Congenital Heart Disease, London, United Kingdom
| | | | - Deane Yim
- Perth Children's Hospital, Department of Paediatric Cardiology, Perth, Australia
| | - Rahul H Rathod
- Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Lilyasari O, Goo HW, Siripornpitak S, Abdul Latiff H, Ota H, Caro-Dominguez P. Multimodality diagnostic imaging for anomalous pulmonary venous connections: a pictorial essay. Pediatr Radiol 2023; 53:2120-2133. [PMID: 37202498 DOI: 10.1007/s00247-023-05660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 05/20/2023]
Abstract
Anomalous pulmonary venous connections represent a heterogeneous group of congenital heart diseases in which a part or all pulmonary venous flow drains directly or indirectly into the right atrium. Clinically, anomalous pulmonary venous connections may be silent or have variable consequences, including neonatal cyanosis, volume overload and pulmonary arterial hypertension due to the left-to-right shunt. Anomalous pulmonary venous connections are frequently associated with other congenital cardiac defects and their accurate diagnosis is crucial for treatment planning. Therefore, multimodality diagnostic imaging, comprising a combination (but not all) of echocardiography, cardiac catheterization, cardiothoracic computed tomography and cardiac magnetic resonance imaging, helps identify potential blind spots relevant to each imaging modality before treatment and achieve optimal management and monitoring. For the same reasons, diagnostic imaging evaluation using a multimodality fashion should be used after treatment. Finally, those interpreting the images should be familiar with the various surgical approaches used to repair anomalous pulmonary venous connections and the common postoperative complications.
Collapse
Affiliation(s)
- Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Republic of Korea.
| | - Suvipaporn Siripornpitak
- Department of Diagnostic and Therapeutic Radiology, Mahidol University Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand
| | - Haifa Abdul Latiff
- Pediatric and Congenital Heart Centre, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Pablo Caro-Dominguez
- Unidad de Radiologia Pediatrica, Servicio de Radiologia, Hospital Universitario Virgen del Rocio, Seville, Spain
| |
Collapse
|
3
|
Moscatelli S, Leo I, Lisignoli V, Boyle S, Bucciarelli-Ducci C, Secinaro A, Montanaro C. Cardiovascular Magnetic Resonance from Fetal to Adult Life-Indications and Challenges: A State-of-the-Art Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050763. [PMID: 37238311 DOI: 10.3390/children10050763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023]
Abstract
Cardiovascular magnetic resonance (CMR) imaging offers a comprehensive, non-invasive, and radiation-free imaging modality, which provides a highly accurate and reproducible assessment of cardiac morphology and functions across a wide spectrum of cardiac conditions spanning from fetal to adult life. It minimises risks to the patient, particularly the risks associated with exposure to ionising radiation and the risk of complications from more invasive haemodynamic assessments. CMR utilises high spatial resolution and provides a detailed assessment of intracardiac and extracardiac anatomy, ventricular and valvular function, and flow haemodynamic and tissue characterisation, which aid in the diagnosis, and, hence, with the management of patients with cardiac disease. This article aims to discuss the role of CMR and the indications for its use throughout the different stages of life, from fetal to adult life.
Collapse
Affiliation(s)
- Sara Moscatelli
- Inherited Cardiovascular Diseases, Great Ormond Street, Children NHS Foundation Trust, London WC1N 3JH, UK
- Paediatric Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 5NP, UK
| | - Isabella Leo
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
- CMR Unit, Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 5NP, UK
| | - Veronica Lisignoli
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
- Adult Congenital Heart Disease Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 5NP, UK
| | - Siobhan Boyle
- Adult Congenital Heart Disease Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 5NP, UK
- Cardiology Department, Logan Hospital, Loganlea Rd, Meadowbrook, QLD 4131, Australia
| | - Chiara Bucciarelli-Ducci
- CMR Unit, Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 5NP, UK
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College University, London SW7 2BX, UK
| | - Aurelio Secinaro
- Radiology Department, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
| | - Claudia Montanaro
- CMR Unit, Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 5NP, UK
- Adult Congenital Heart Disease Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 5NP, UK
- National Heart and Lung Institute, Imperial Collage London, Dovehouse St, London SW3 6LY, UK
| |
Collapse
|
4
|
Caro-Domínguez P, Secinaro A, Valverde I, Fouilloux V. Imaging and surgical management of congenital heart diseases. Pediatr Radiol 2023; 53:677-694. [PMID: 36334120 DOI: 10.1007/s00247-022-05536-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/01/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
Abstract
Congenital heart disease affects approximately 1% of live births per year. In recent years, there has been a decrease in the morbidity and mortality of these cases due to advances in medical and surgical care. Imaging plays a key role in the management of these children, with chest radiography, echocardiography and chest ultrasound the first diagnostic tools, and cardiac computed tomography, catheterization and magnetic resonance imaging reserved to assess better the anatomy and physiology of the most complex cases. This article is a beginner's guide to the anatomy of the most frequent congenital heart diseases (atrial and ventricular septal defects, abnormal pulmonary venous connections, univentricular heart, tetralogy of Fallot, transposition of the great arteries and coarctation of the aorta), their surgical management, the most common postsurgical complications, deciding which imaging modality is needed, and when and how to image gently.
Collapse
Affiliation(s)
- Pablo Caro-Domínguez
- Pediatric Radiology Unit, Department of Radiology, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, Seville, Spain.
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Israel Valverde
- Pediatric Cardiology Unit and Cardiovascular Pathology Unit, Hospital Universitario Virgen del Rocio and Institute of Biomedicine of Seville, Seville, Spain
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Virginie Fouilloux
- Department of Congenital and Pediatric Cardiac Surgery, Timone Children Hospital, Marseille, France
| |
Collapse
|
5
|
Jahnke C, Bollmann A, Oebel S, Lindemann F, Daehnert I, Riede FT, Hindricks G, Paetsch I. Cardiovascular magnetic resonance pulmonary perfusion for guidance of interventional treatment of pulmonary vein stenosis. J Cardiovasc Magn Reson 2022; 24:70. [PMID: 36503589 PMCID: PMC9743617 DOI: 10.1186/s12968-022-00904-x] [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: 06/09/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Pulmonary vein (PV) stenosis represents a rare but serious complication following radiofrequency ablation of atrial fibrillation with a comprehensive diagnosis including morphological stenosis grading together with the assessment of its functional consequences being imperative within the relatively narrow window for therapeutic intervention. The present study determined the clinical utility of a combined, single-session cardiovascular magnetic resonance (CMR) imaging protocol integrating pulmonary perfusion and PV angiographic assessment for pre-procedural planning and follow-up of patients referred for interventional PV stenosis treatment. METHODS CMR examinations (cine imaging, dynamic pulmonary perfusion, three-dimensional PV angiography) were performed in 32 consecutive patients prior to interventional treatment of PV stenosis and at 1-day and 3-months follow-up. Degree of PV stenosis was visually determined on CMR angiography; visual and quantitative analysis of pulmonary perfusion imaging was done for all five lung lobes. RESULTS Interventional treatment of PV stenosis achieved an acute procedural success rate of 90%. Agreement between visually evaluated pulmonary perfusion imaging and the presence or absence of a ≥ 70% PV stenosis was nearly perfect (Cohen's kappa, 0.96). ROC analysis demonstrated high discriminatory power of quantitative pulmonary perfusion measurements for the detection of ≥ 70% PV stenosis (AUC for time-to-peak enhancement, 0.96; wash-in rate, 0.93; maximum enhancement, 0.90). Quantitative pulmonary perfusion analysis proved a very large treatment effect attributable to successful PV revascularization already after 1 day. CONCLUSION Integration of CMR pulmonary perfusion imaging into the clinical work-up of patients with PV stenosis allowed for efficient peri-procedural stratification and follow-up evaluation of revascularization success.
Collapse
Affiliation(s)
- Cosima Jahnke
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sabrina Oebel
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Frank Lindemann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Ingo Daehnert
- Department of Pediatric Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Frank-Thomas Riede
- Department of Pediatric Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Ingo Paetsch
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany.
| |
Collapse
|
6
|
Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the use of cardiovascular magnetic resonance in pediatric congenital and acquired heart disease : Endorsed by The American Heart Association. J Cardiovasc Magn Reson 2022; 24:37. [PMID: 35725473 PMCID: PMC9210755 DOI: 10.1186/s12968-022-00843-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of CMR in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of CMR in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
Collapse
Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA
| |
Collapse
|
7
|
Lydiard S, Pontré B, Lowe BS, Keall P. Atrial fibrillation cardiac radioablation target visibility on magnetic resonance imaging. Phys Eng Sci Med 2022; 45:757-767. [PMID: 35687311 PMCID: PMC9448688 DOI: 10.1007/s13246-022-01141-3] [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: 10/05/2021] [Accepted: 05/16/2022] [Indexed: 11/27/2022]
Abstract
Magnetic resonance imaging (MRI) guided cardiac radioablation (CR) for atrial fibrillation (AF) is a promising treatment concept. However, the visibility of AF CR targets on MRI acquisitions requires further exploration and MRI sequence and parameter optimization has not yet been performed for this application. This pilot study explores the feasibility of MRI-guided tracking of AF CR targets by evaluating AF CR target visualization on human participants using a selection of 3D and 2D MRI sequences.MRI datasets were acquired in healthy and AF participants using a range of MRI sequences and parameters. MRI acquisition categories included 3D free-breathing acquisitions (3Dacq), 2D breath-hold ECG-gated acquisitions (2DECG-gated), stacks of 2D breath-hold ECG-gated acquisitions which were retrospectively interpolated to 3D datasets (3Dinterp), and 2D breath-hold ungated acquisitions (2Dreal-time). The ease of target delineation and the presence of artifacts were qualitatively analyzed. Image quality was quantitatively analyzed using signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and non-uniformity. Confident 3D target delineation was achievable on all 3Dinterp datasets but was not possible on any of the 3Dacq datasets. Fewer artifacts and significantly better SNR, CNR and non-uniformity metrics were observed with 3Dinterp compared to 3Dacq. 2Dreal-time datasets had slightly lower SNR and CNR than 2DECG-gated and 3Dinterp n datasets. AF CR target visualization on MRI was qualitatively and quantitatively evaluated. The study findings indicate that AF CR target visualization is achievable despite the imaging challenges associated with these targets, warranting further investigation into MRI-guided AF CR treatments.
Collapse
Affiliation(s)
- Suzanne Lydiard
- ACRF Image X Institute, University of Sydney, 1 Central Avenue, Eveleigh, NSW, Australia. .,Kathleen Kilgour Centre, 18 Twentieth Avenue, Tauranga South, Tauranga, New Zealand.
| | - Beau Pontré
- Department of Anatomy and Medical Imaging, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - Boris S Lowe
- Green Lane Cardiovascular Service, Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand
| | - Paul Keall
- ACRF Image X Institute, University of Sydney, 1 Central Avenue, Eveleigh, NSW, Australia
| |
Collapse
|
8
|
Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the Use of Cardiac Magnetic Resonance in Pediatric Congenital and Acquired Heart Disease: Endorsed by The American Heart Association. Circ Cardiovasc Imaging 2022; 15:e014415. [PMID: 35727874 PMCID: PMC9213089 DOI: 10.1161/circimaging.122.014415] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cardiovascular magnetic resonance has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of cardiovascular magnetic resonance in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of cardiovascular magnetic resonance in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
Collapse
Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, (M.A.F.).,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, (M.A.F.)
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA, (S.A.)
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA, (C.B.)
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA, (L.B.)
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA, (T.C.)
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA, (T.J.)
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK, (V.M.)
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA, (M.T.)
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA (C.W.)
| |
Collapse
|
9
|
Kuo JA, Petit CJ. Pulmonary Vein Stenosis in Children: A Programmatic Approach Employing Primary and Anatomic Therapy. CHILDREN 2021; 8:children8080663. [PMID: 34438554 PMCID: PMC8392344 DOI: 10.3390/children8080663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022]
Abstract
Pulmonary vein stenosis (PVS) is a difficult condition to treat due to recurrence and progression. In 2017, we developed a comprehensive PVS Program at our center to address the multidisciplinary needs of these patients. We discuss the components of our program and our approach to these patients, using a combination of primary (medical) therapy in addition to anatomic therapy to preserve vessel patency. A multidisciplinary approach to treating these challenging patients is critical.
Collapse
Affiliation(s)
- James A. Kuo
- Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA 30322, USA;
| | - Christopher J. Petit
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, Morgan Stanley Children’s Hospital of New York, BN-263a, Pediatric Cardiology, 3859 Broadway, New York, NY 10032, USA
- Correspondence:
| |
Collapse
|
10
|
Pulmonary vein stenosis: Treatment and challenges. J Thorac Cardiovasc Surg 2021; 161:2169-2176. [DOI: 10.1016/j.jtcvs.2020.05.117] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/19/2020] [Accepted: 05/23/2020] [Indexed: 11/15/2022]
|
11
|
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.
Collapse
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.
| |
Collapse
|
12
|
Cardiac magnetic resonance imaging and computed tomography for the pediatric cardiologist. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
13
|
Lee JW, Hur JH, Yang DH, Lee BY, Im DJ, Hong SJ, Kim EY, Park EA, Jo Y, Kim J, Park CH, Yong HS. Guidelines for Cardiovascular Magnetic Resonance Imaging from the Korean Society of Cardiovascular Imaging-Part 2: Interpretation of Cine, Flow, and Angiography Data. Korean J Radiol 2020; 20:1477-1490. [PMID: 31606953 PMCID: PMC6791819 DOI: 10.3348/kjr.2019.0407] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 07/19/2019] [Indexed: 11/15/2022] Open
Abstract
Cardiovascular magnetic resonance imaging (CMR) is expected to be increasingly used in Korea due to technological advances and the expanded national insurance coverage of CMR assessments. For improved patient care, proper acquisition of CMR images as well as their accurate interpretation by well-trained personnel are equally important. In response to the increased demand for CMR, the Korean Society of Cardiovascular Imaging (KOSCI) has issued interpretation guidelines in conjunction with the Korean Society of Radiology. KOSCI has also created a formal Committee on CMR guidelines to create updated practices. The members of this committee review previously published interpretation guidelines and discuss the patterns of CMR use in Korea.
Collapse
Affiliation(s)
- Jae Wook Lee
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Bucheon, Korea
| | - Jee Hye Hur
- Department of Radiology, Hanil General Hospital, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Bae Young Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Dong Jin Im
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Hong
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Eun Young Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yeseul Jo
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - JeongJae Kim
- Department of Radiology, Jeju National University Hospital, Jeju, Korea
| | - Chul Hwan Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
| |
Collapse
|
14
|
How many versus how much: comprehensive haemodynamic evaluation of partial anomalous pulmonary venous connection by cardiac MRI. Eur Radiol 2018; 28:4598-4606. [PMID: 29721685 DOI: 10.1007/s00330-018-5428-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 03/08/2018] [Accepted: 03/15/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The objective of this study was to investigate the effect of location and number of anomalously connected pulmonary veins and any associated atrial septal defect (ASD) on the magnitude of left-to-right shunting in patients with partial anomalous pulmonary venous connection (PAPVC), and how that influences right ventricular volume loading. METHODS AND RESULTS The cardiac magnetic resonance (CMR) and echocardiography examinations of 26 paediatric patients (mean age, 11.2 ± 5.1 years) with unrepaired PAPVC were analysed. Fourteen patients had right-sided, 11 left-sided and 1 patient bilateral PAPVC. An ASD was present in 11 patients, of which none had a Qp/Qs < 1.5 and 8 had a Qp/Qs≥ 2.0. No patient with isolated left upper PAPVC experienced a Qp/Qs ≥ 2.0 compared to 9/12 patients with right upper PAPVC. Qp/Qs correlated with indexed right ventricle (RV) end-diastolic volume (RVEDVi, r = 0.59, p = 0.002) by CMR and with echocardiographic right ventricular end-diastolic dimension (RVED) z-score (r = 0.68, p = 0.003). A RVEDVi >124 ml/m2 by CMR and a RVED z-score >2.2 by echocardiography identified patients with a Qp/Qs ≥1.5 with good sensitivity and specificity. CONCLUSIONS An asymptomatic patient with a single anomalously connected left upper pulmonary vein and without an ASD is unlikely to have a significant left-to-right shunt. On the other hand, right-sided PAPVC is frequently associated with a significant left-to-right shunt, especially when an ASD is present. KEY POINTS • Patients with PAPVC and ASD routinely have a significant left-to-right shunt. • Patients with right PAPVC are likely to have a significant left-to-right shunt. • Patients with left PAPVC are unlikely to have a significant left-to-right shunt. • CMR is helpful in decision-making for patients with PAPVC.
Collapse
|
15
|
Vanderlaan RD, Caldarone CA. Surgical Approaches to Total Anomalous Pulmonary Venous Connection. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2018; 21:83-91. [PMID: 29425529 DOI: 10.1053/j.pcsu.2017.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/14/2017] [Indexed: 06/08/2023]
Abstract
Total anomalous pulmonary venous connection (TAPVC) constitutes a spectrum of congenital lesions whereby the pulmonary veins remain connected to systemic venous vessels or aberrantly connect to the right atrium. Definitive management requires surgical intervention and, in patients with obstruction to pulmonary venous flow, urgent operation is required. Use of temporizing catheter-based interventions allow for optimization in hemodynamically unstable neonates. Overall, survival has significantly improved over the past decades through better perioperative management and evolution of surgical approaches to minimize post-repair pulmonary vein stenosis, which persists as a major determinant of long-term outcomes.
Collapse
Affiliation(s)
- Rachel D Vanderlaan
- University of Toronto, Division of Cardiac Surgery, Toronto, Ontario, Canada
| | | |
Collapse
|
16
|
Tremblay C, Yoo SJ, Mertens L, Seed M, Jacques F, Slorach C, Vanderlaan R, Greenway S, Caldarone C, Coles J, Grosse-Wortmann L. Sutureless Versus Conventional Pulmonary Vein Repair: A Magnetic Resonance Pilot Study. Ann Thorac Surg 2018; 105:1248-1254. [PMID: 29482852 DOI: 10.1016/j.athoracsur.2017.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Two different surgical techniques are used to repair anomalous pulmonary venous connection or pulmonary vein (PV) stenosis: the classic repair (CR) and the sutureless repair (SR). The purpose of this study was to compare the prevalence of PV stenosis between the two surgical approaches. METHODS Patients were prospectively recruited irrespective of symptoms or previous imaging findings. Cardiac magnetic resonance imaging and echocardiography were performed in a blinded fashion on the same day. RESULTS Twenty-five patients (13 male) after PV repair completed the study. Twelve patients had undergone CR and 13 SR (in 1 patient as a reoperation after CR). The median age at operation was 2 months (range: 1 day to 5 years) and was similar for both groups; the median age at the time of cardiac magnetic resonance was 9 years (range: 6 to 17 years) and 9 years (range: 6 to 14 years) for the CR and SR, respectively. Four patients had PV stenosis. All 4 patients had had total anomalous pulmonary venous connection, 1 patient had undergone repair with the CR and 2 with a primary SR; 1 patient had first undergone a CR, followed by a SR for stenosis. Echocardiography provided complete visualization of all PVs in only 11 patients (44%). Notable stenosis of at least one PV was missed by echocardiography in 2 patients. CONCLUSIONS This pilot study indicates that not only CR but also SR may be burdened by a risk of postoperative PV stenosis. Magnetic resonance imaging should be used routinely for the postoperative monitoring for the development of PV obstruction.
Collapse
Affiliation(s)
- Cornelia Tremblay
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Shi-Joon Yoo
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Luc Mertens
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mike Seed
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Frederic Jacques
- Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cameron Slorach
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Vanderlaan
- Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Steven Greenway
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Caldarone
- Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - John Coles
- Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lars Grosse-Wortmann
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
17
|
DeCampli WM. Pulmonary vein stenosis: Plea for a multi-institutional registry. J Thorac Cardiovasc Surg 2016; 151:667-668. [DOI: 10.1016/j.jtcvs.2015.09.097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/23/2015] [Indexed: 11/27/2022]
|
18
|
Pulmonary vein stenosis: Severity and location predict survival after surgical repair. J Thorac Cardiovasc Surg 2016; 151:657-666.e2. [DOI: 10.1016/j.jtcvs.2015.08.121] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/25/2015] [Accepted: 08/29/2015] [Indexed: 11/22/2022]
|
19
|
Repair Type Influences Mode of Pulmonary Vein Stenosis in Total Anomalous Pulmonary Venous Drainage. Ann Thorac Surg 2015; 100:654-62. [DOI: 10.1016/j.athoracsur.2015.04.121] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/20/2015] [Accepted: 04/23/2015] [Indexed: 11/19/2022]
|
20
|
Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI. Cardiol Young 2015; 25:819-38. [PMID: 25739865 DOI: 10.1017/s1047951115000025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.
Collapse
|
21
|
Anatomical risk factors, surgical treatment, and clinical outcomes of left-sided pulmonary vein obstruction in single-ventricle patients. J Thorac Cardiovasc Surg 2015; 149:1332-8. [DOI: 10.1016/j.jtcvs.2014.11.089] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 10/25/2014] [Accepted: 11/29/2014] [Indexed: 11/24/2022]
|
22
|
Transposition of the great arteries and sinus venosus defect with partially anomalous pulmonary venous return: physiological and anatomic considerations. Cardiol Young 2015; 25:787-9. [PMID: 24905964 DOI: 10.1017/s104795111400105x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transposition of the great arteries is a common congenital heart defect causing cyanosis in neonates, occurring in 0.2 per 1000 live births. It has been reported to occur with other associated congenital heart lesions. However, its association with a superior sinus venosus defect and partially anomalous pulmonary venous return has not been reported. We present a neonate with transposition of the great arteries, superior sinus venosus defect with partially anomalous pulmonary venous return that underwent successful complete neonatal repair, and discuss important physiological and anatomic considerations.
Collapse
|
23
|
Valsangiacomo Buechel ER, Grosse-Wortmann L, Fratz S, Eichhorn J, Sarikouch S, Greil GF, Beerbaum P, Bucciarelli-Ducci C, Bonello B, Sieverding L, Schwitter J, Helbing WA, Galderisi M, Miller O, Sicari R, Rosa J, Thaulow E, Edvardsen T, Brockmeier K, Qureshi S, Stein J. Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI. Eur Heart J Cardiovasc Imaging 2015; 16:281-97. [PMID: 25712078 DOI: 10.1093/ehjci/jeu129] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.
Collapse
|
24
|
Helbing WA, Ouhlous M. Cardiac magnetic resonance imaging in children. Pediatr Radiol 2015; 45:20-6. [PMID: 25552387 DOI: 10.1007/s00247-014-3175-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/30/2014] [Accepted: 08/22/2014] [Indexed: 02/05/2023]
Abstract
MRI is an important additional tool in the diagnostic work-up of children with congenital heart disease. This review aims to summarise the role MRI has in this patient population. Echocardiography remains the main diagnostic tool in congenital heart disease. In specific situations, MRI is used for anatomical imaging of congenital heart disease. This includes detailed assessment of intracardiac anatomy with 2-D and 3-D sequences. MRI is particularly useful for assessment of retrosternal structures in the heart and for imaging large vessel anatomy. Functional assessment includes assessment of ventricular function using 2-D cine techniques. Of particular interest in congenital heart disease is assessment of right and single ventricular function. Two-dimensional and newer 3-D techniques to quantify flow in these patients are or will soon become an integral part of quantification of shunt size, valve function and complex flow patterns in large vessels. More advanced uses of MRI include imaging of cardiovascular function during stress and tissue characterisation of the myocardium. Techniques used for this purpose need further validation before they can become part of the daily routine of MRI assessment of congenital heart disease.
Collapse
Affiliation(s)
- Willem A Helbing
- Department of Radiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands,
| | | |
Collapse
|
25
|
Babu B, Caldarone CA. Management of tetralogy of Fallot with unilateral absence of pulmonary artery: an overview. World J Pediatr Congenit Heart Surg 2014; 5:70-9. [PMID: 24403358 DOI: 10.1177/2150135113506597] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tetralogy of Fallot with unilateral absence of pulmonary artery (PA) is a rare congenital anomaly that has been reported in isolated case reports and small case series. There is no well-defined treatment algorithm for these patients, and repair has been associated with high mortality, although survival is improving in the more recent era. Recent reports suggest strict case selection criteria based on PA dimensions and size of the left ventricle.
Collapse
Affiliation(s)
- Balram Babu
- Department of Cardiothoracic Surgery, Apollo Hospitals, Bangalore, Karnataka, India
| | | |
Collapse
|
26
|
Geva T. Is MRI the preferred method for evaluating right ventricular size and function in patients with congenital heart disease?: MRI is the preferred method for evaluating right ventricular size and function in patients with congenital heart disease. Circ Cardiovasc Imaging 2014; 7:190-7. [PMID: 24449548 DOI: 10.1161/circimaging.113.000553] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tal Geva
- Department of Cardiology, Boston Children's Hospital, Boston, MA; and Department of Pediatrics, Harvard Medical School, Boston, MA
| |
Collapse
|
27
|
Wong DTH, Lee KJ, Yoo SJ, Tomlinson G, Grosse-Wortmann L. Changes in systemic and pulmonary blood flow distribution in normal adult volunteers in response to posture and exercise: a phase contrast magnetic resonance imaging study. J Physiol Sci 2014; 64:105-12. [PMID: 24385190 PMCID: PMC10717753 DOI: 10.1007/s12576-013-0298-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 11/19/2013] [Indexed: 11/30/2022]
Abstract
Hemodynamics are usually evaluated in the supine position at rest. This is only a snapshot of an individual's daily activities. This study describes circulatory adaptation, as assessed by magnetic resonance imaging, to changes in position and exercise. Phase contrast magnetic resonance imaging of blood flow within systemic and pulmonary arteries and veins was performed in 24 healthy volunteers at rest in the prone and supine position and with bicycle exercise in the supine position. No change was seen in systemic blood flow when moving from prone to supine. Exercise resulted in an increased percentage of cardiac output towards the lower body. Changes in position resulted in a redistribution of blood flow within the left lung--supine positioning resulted in decreased blood flow to the left lower pulmonary vein. With exercise, both the right and left lower lobes received increased blood flow, while the upper lobes received less.
Collapse
Affiliation(s)
- Derek T H Wong
- The Labatt Family Heart Centre at the Hospital for Sick Children, Department of Paediatrics, University of Toronto, Ontario, Canada,
| | | | | | | | | |
Collapse
|
28
|
Grosse-Wortmann L, Yoo SJ, van Arsdell G, Chetan D, Macdonald C, Benson L, Honjo O. Preoperative total pulmonary blood flow predicts right ventricular pressure in patients early after complete repair of tetralogy of Fallot and pulmonary atresia with major aortopulmonary collateral arteries. J Thorac Cardiovasc Surg 2013; 146:1185-90. [DOI: 10.1016/j.jtcvs.2013.01.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 12/15/2012] [Accepted: 01/14/2013] [Indexed: 11/26/2022]
|
29
|
Kato H, Fu YY, Zhu J, Wang L, Aafaqi S, Rahkonen O, Slorach C, Traister A, Leung CH, Chiasson D, Mertens L, Benson L, Weisel RD, Hinz B, Maynes JT, Coles JG, Caldarone CA. Pulmonary vein stenosis and the pathophysiology of "upstream" pulmonary veins. J Thorac Cardiovasc Surg 2013; 148:245-53. [PMID: 24084286 DOI: 10.1016/j.jtcvs.2013.08.046] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/10/2013] [Accepted: 08/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Surgical and catheter-based interventions on pulmonary veins are associated with pulmonary vein stenosis (PVS), which can progress diffusely through the "upstream" pulmonary veins. The mechanism has been rarely studied. We used a porcine model of PVS to assess disease progression with emphasis on the potential role of endothelial-mesenchymal transition (EndMT). METHODS Neonatal piglets underwent bilateral pulmonary vein banding (banded, n = 6) or sham operations (sham, n = 6). Additional piglets underwent identical banding and stent implantation in a single-banded pulmonary vein 3 weeks postbanding (stented, n = 6). At 7 weeks postbanding, hemodynamics and upstream PV pathology were assessed. RESULTS Banded piglets developed pulmonary hypertension. The upstream pulmonary veins exhibited intimal thickening associated with features of EndMT, including increased transforming growth factor (TGF)-β1 and Smad expression, loss of endothelial and gain of mesenchymal marker expression, and coexpression of endothelial and mesenchymal markers in banded pulmonary vein intimal cells. These immunopathologic changes and a prominent myofibroblast phenotype in the remodeled pulmonary veins were consistently identified in specimens from patients with PVS, in vitro TGF-β1-stimulated cells isolated from piglet and human pulmonary veins, and human umbilical vein endothelial cells. After stent implantation, decompression of a pulmonary vein was associated with reappearance of endothelial marker expression, suggesting the potential for plasticity in the observed pathologic changes, followed by rapid in-stent restenosis. CONCLUSIONS Neonatal pulmonary vein banding in piglets recapitulates critical aspects of clinical PVS and highlights a pathologic profile consistent with EndMT, supporting the rationale for evaluating therapeutic strategies designed to exploit reversibility of upstream pulmonary vein pathology.
Collapse
Affiliation(s)
- Hideyuki Kato
- Division of Cardiovascular Surgery, Hospital for Sick Children, Labatt Family Heart Center and University of Toronto, Toronto, Ontario, Canada
| | - Yaqin Yana Fu
- Division of Cardiovascular Surgery, Hospital for Sick Children, Labatt Family Heart Center and University of Toronto, Toronto, Ontario, Canada
| | - Jiaquan Zhu
- Division of Cardiovascular Surgery, Hospital for Sick Children, Labatt Family Heart Center and University of Toronto, Toronto, Ontario, Canada
| | - Lixing Wang
- Division of Cardiovascular Surgery, Hospital for Sick Children, Labatt Family Heart Center and University of Toronto, Toronto, Ontario, Canada
| | - Shabana Aafaqi
- Division of Cardiovascular Surgery, Hospital for Sick Children, Labatt Family Heart Center and University of Toronto, Toronto, Ontario, Canada
| | - Otto Rahkonen
- Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cameron Slorach
- Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alexandra Traister
- Division of Cardiovascular Surgery, Hospital for Sick Children, Labatt Family Heart Center and University of Toronto, Toronto, Ontario, Canada
| | - Chung Ho Leung
- Division of Cardiovascular Surgery, Hospital for Sick Children, Labatt Family Heart Center and University of Toronto, Toronto, Ontario, Canada
| | - David Chiasson
- Division of Pathology and Paediatric Laboratory Medicine, Laboratory of Tissue Repair and Regeneration, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Luc Mertens
- Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lee Benson
- Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Richard D Weisel
- Division of Cardiac Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Boris Hinz
- Laboratory of Tissue Repair and Regeneration, Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Jason T Maynes
- Division of Anaesthesia and Pain Medicine and Molecular Structure and Function, Hospital for Sick Children, Toronto, Ontario, Canada
| | - John G Coles
- Division of Cardiovascular Surgery, Hospital for Sick Children, Labatt Family Heart Center and University of Toronto, Toronto, Ontario, Canada
| | - Christopher A Caldarone
- Division of Cardiovascular Surgery, Hospital for Sick Children, Labatt Family Heart Center and University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
30
|
Schulz-Menger J, Bluemke DA, Bremerich J, Flamm SD, Fogel MA, Friedrich MG, Kim RJ, von Knobelsdorff-Brenkenhoff F, Kramer CM, Pennell DJ, Plein S, Nagel E. Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for Cardiovascular Magnetic Resonance (SCMR) board of trustees task force on standardized post processing. J Cardiovasc Magn Reson 2013; 15:35. [PMID: 23634753 PMCID: PMC3695769 DOI: 10.1186/1532-429x-15-35] [Citation(s) in RCA: 828] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 03/05/2013] [Indexed: 01/29/2023] Open
Abstract
With mounting data on its accuracy and prognostic value, cardiovascular magnetic resonance (CMR) is becoming an increasingly important diagnostic tool with growing utility in clinical routine. Given its versatility and wide range of quantitative parameters, however, agreement on specific standards for the interpretation and post-processing of CMR studies is required to ensure consistent quality and reproducibility of CMR reports. This document addresses this need by providing consensus recommendations developed by the Task Force for Post Processing of the Society for Cardiovascular MR (SCMR). The aim of the task force is to recommend requirements and standards for image interpretation and post processing enabling qualitative and quantitative evaluation of CMR images. Furthermore, pitfalls of CMR image analysis are discussed where appropriate.
Collapse
Affiliation(s)
- Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité Medical University Berlin, Berlin, Germany
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Jens Bremerich
- Department of Radiology of the University Hospital Basel, Basel, Switzerland
| | - Scott D Flamm
- Imaging, and Heart and Vascular Institutes, Cleveland Clinic, Cleveland, OH, USA
| | - Mark A Fogel
- Department of Radiology, Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Matthias G Friedrich
- CMR Centre at the Montreal Heart Institute, Department of Cardiology, Université de Montréal, Montreal, Canada
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, and Departments of Medicine and Radiology, Duke University, University Medical Center, Durham, NC, USA
| | - Florian von Knobelsdorff-Brenkenhoff
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité Medical University Berlin, Berlin, Germany
| | - Christopher M Kramer
- Departments of Medicine and Radiology and the Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Sven Plein
- Leeds Institute for Genetics Health and Therapeutics & Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - Eike Nagel
- Division of Imaging Sciences and Biomedical Engineering, Department of Cardiovascular Imaging, King’s College, London, UK
| |
Collapse
|
31
|
Seale AN, Uemura H, Webber SA, Partridge J, Roughton M, Ho SY, McCarthy KP, Jones S, Shaughnessy L, Sunnegardh J, Hanseus K, Berggren H, Johansson S, Rigby ML, Keeton BR, Daubeney PE. Total anomalous pulmonary venous connection: Outcome of postoperative pulmonary venous obstruction. J Thorac Cardiovasc Surg 2013; 145:1255-62. [DOI: 10.1016/j.jtcvs.2012.06.031] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 05/09/2012] [Accepted: 06/12/2012] [Indexed: 11/16/2022]
|
32
|
Late stenosis after repair of anomalous pulmonary venous drainage and the value of cardiovascular magnetic resonance for assessment of this important complication. Pediatr Cardiol 2013; 34:480-2. [PMID: 23076498 DOI: 10.1007/s00246-012-0518-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 09/06/2012] [Indexed: 10/27/2022]
|
33
|
Mądry W, Karolczak MA. Totally anomalous pulmonary venous drainage - supracardiac type: ultrasound assessment of anatomically determined stenosis of the vertical vein collecting pulmonary venous return. J Ultrason 2012; 12:479-86. [PMID: 26675781 PMCID: PMC4603229 DOI: 10.15557/jou.2012.0035] [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: 05/09/2012] [Revised: 06/06/2012] [Accepted: 12/11/2012] [Indexed: 11/29/2022] Open
Abstract
The diagnosis of the congenital heart defects, among others totally anomalous pulmonary venous drainage, is based on echocardiography. While the visualization of intracardiac structures rarely causes significant difficulties, the vessels positioned outside the heart, e.g. the pulmonary veins, are often hidden behind tissues impermeable to ultrasounds, which may necessitate the use of other imaging methods, such as computer tomography, nuclear magnetic resonance or angiocardiography. The serious limitation of these techniques, especially in pediatric age, is the necessity to administer general anesthesia and contrast media. In order to obtain clear images, the appropriate concentration of a contrast agent in the vessels is necessary, which is not always possible in a patient with severe circulatory failure. Therefore, every effort should be made to obtain as much information necessary for treatment determination as possible from echocardiography, in spite of its limitations. A significant morphological factor of totally anomalous pulmonary venous drainage is the connection between the pulmonary and systemic veins, which in the supracardiac type is the vertical vein draining into the left brachiocephalic vein. The narrowing of this connection impedes the return of the blood from the lungs, which leads to the secondary edema and severe, abrupt cardiorespiratory insufficiency. Such a narrowing should be sought for in every case of totally anomalous pulmonary venous drainage since it constitutes an indication for an urgent surgery. On the basis of own experience and information obtained from the pertinent literature, the authors describe the rules and criteria of the diagnosis of this rare supracardiac form of the heart defect with the presence of the vertical vein which may undergo stenosis due to a phenomenon called the anatomical or bronchoarterial vise. It is formed when the vessel “pushes through” a narrow opening bordered by the left pulmonary artery from the inferior side as well as the left main bronchus and the arterial duct or ligament from the superior side. This article describes a technique of echocardiographic test enabling the precise visualization of the vessel's course and the differentiation from a more common variant of the defect – without external stenosis.
Collapse
Affiliation(s)
- Wojciech Mądry
- II Katedra i Klinika Kardiochirurgii i Chirurgii Ogólnej Dzieci, Warszawki Uniwersytet Medyczny, Warszawa, Polska
| | - Maciej A Karolczak
- II Katedra i Klinika Kardiochirurgii i Chirurgii Ogólnej Dzieci, Warszawki Uniwersytet Medyczny, Warszawa, Polska
| |
Collapse
|
34
|
Grosse-Wortmann L, Dragulescu A, Drolet C, Chaturvedi R, Kotani Y, Mertens L, Taylor K, La Rotta G, van Arsdell G, Redington A, Yoo SJ. Determinants and clinical significance of flow via the fenestration in the Fontan pathway: a multimodality study. Int J Cardiol 2012; 168:811-7. [PMID: 23164583 DOI: 10.1016/j.ijcard.2012.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 09/19/2012] [Accepted: 10/07/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The use of a fenestration in the Fontan pathway remains controversial, partly because its hemodynamic effects and clinical consequences are insufficiently understood. The objective of this study was to quantify the magnitude of fenestration flow and to characterize its hemodynamic consequences after an intermediate interval after surgery. METHODS Twenty three patients with a fenestrated extracardiac conduit prospectively underwent investigation by cardiac magnetic resonance (CMR), echocardiography, and invasive manometry under the same general anesthetic 12 ± 4 months after Fontan surgery. Fenestration flow was determined using phase contrast CMR by subtracting flow in the Fontan pathway above the fenestration from Fontan flow below the fenestration. RESULTS Fenestration flow constituted a mean of 31 ± 12% (range 8-50%) of ventricular preload. It was associated with a lower Qp/Qs (r = -0.64, p=0.001) and oxygen saturation (r = -0.74, p<0.0001). Fenestration flow volume was correlated with pulmonary vascular resistance (r = 0.45, p = 0.04) and markers of ventricular diastolic function (early diastolic strain rate r = 0.57, p = 0.008 and ventricular untwist rate r = 0.54, p = 0.02). In 14 patients (61%) all of the net inferior vena cava flow and part of the superior vena cava flow were diverted into the systemic atrium and did not reach the lungs. CONCLUSIONS Fenestration flow can be measured accurately with CMR. In two-thirds of the patients not only all of the inferior vena cava flow, but also some of the superior vena cava flow is diverted through the fenestration. Fenestration flow is driven by a balance between pulmonary vascular resistance and early diastolic ventricular function.
Collapse
Affiliation(s)
- Lars Grosse-Wortmann
- The Labatt Family Heart Centre and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Achenbach S, Barkhausen J, Beer M, Beerbaum P, Dill T, Eichhorn J, Fratz S, Gutberlet M, Hoffmann M, Huber A, Hunold P, Klein C, Krombach G, Kreitner KF, Kühne T, Lotz J, Maintz D, Marholdt H, Merkle N, Messroghli D, Miller S, Paetsch I, Radke P, Steen H, Thiele H, Sarikouch S, Fischbach R. Konsensusempfehlungen der DRG/DGK/DGPK zum Einsatz der Herzbildgebung mit Computertomographie und Magnetresonanztomographie. KARDIOLOGE 2012. [DOI: 10.1007/s12181-012-0417-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
36
|
Prakash A, Rathod RH, Powell AJ, McElhinney DB, Banka P, Geva T. Relation of systemic-to-pulmonary artery collateral flow in single ventricle physiology to palliative stage and clinical status. Am J Cardiol 2012; 109:1038-45. [PMID: 22221948 DOI: 10.1016/j.amjcard.2011.11.040] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 11/08/2011] [Accepted: 11/08/2011] [Indexed: 11/17/2022]
Abstract
Systemic-to-pulmonary collateral arteries (SPCs) are common in patients with single-ventricle physiology, but their impact on clinical outcomes is unclear. The aim of this study was to use retrospective cardiac magnetic resonance data to determine the relation between SPC flow and palliative stage and clinical status in single-ventricle physiology. Of 116 patients, 78 were after Fontan operation (median age 19 years) and 38 were at an earlier palliative stage (median age 2 years). SPC flow was quantified as aortic flow minus total caval flow or total pulmonary vein flow minus total branch pulmonary artery flow. Median SPC flow/body surface area (BSA) was higher in the pre-Fontan group (1.06 vs 0.43 L/min/m(2), p <0.0001) and decreased nonlinearly with increasing age after the Fontan operation (r(2) = 0.17, p <0.0001). In the Fontan group, patients in the highest quartile of SPC flow had larger ventricular end-diastolic volume/BSA (p <0.0001) and were older at the time of Fontan surgery (p = 0.04), but SPC flow/BSA was not associated with heart failure symptoms, atrial or ventricular arrhythmias, atrioventricular valve regurgitation, the ventricular ejection fraction, or peak oxygen consumption. In multivariate analysis of all patients (n = 116), higher SPC flow was independently associated with pre-Fontan status, unilateral branch pulmonary artery stenosis, a diagnosis of hypoplastic left-heart syndrome, and previous catheter occlusion of SPCs (model r(2) = 0.37, p <0.0001). In conclusion, in this cross-sectional study of single-ventricle patients, BSA-adjusted SPC flow was highest in pre-Fontan patients and decreased after the Fontan operation with minimal clinical correlates aside from ventricular dilation.
Collapse
Affiliation(s)
- Ashwin Prakash
- Department of Cardiology, Children's Hospital Boston, Massachusetts, USA.
| | | | | | | | | | | |
Collapse
|
37
|
Mizouni H, Attia M, Zaidi J, Menif E. Atypical partial anomalous pulmonary venous drainage of the left upper pulmonary vein through a compressed vertical vein between the aorta and the pulmonary artery. Pediatr Cardiol 2011; 32:1271-2. [PMID: 21968579 DOI: 10.1007/s00246-011-0134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 09/12/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Habiba Mizouni
- Department of Radiology, La Rabta University Hospital, Jebbari, 1007, Tunis, Tunisia.
| | | | | | | |
Collapse
|
38
|
Greenway SC, Yoo SJ, Baliulis G, Caldarone C, Coles J, Grosse-Wortmann L. Assessment of pulmonary veins after atrio-pericardial anastomosis by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2011; 13:72. [PMID: 22104689 PMCID: PMC3283501 DOI: 10.1186/1532-429x-13-72] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 11/21/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The atrio-pericardial anastomosis (APA) uses a pericardial pouch to create a large communication between the left atrium and the pulmonary venous contributaries in order to avoid direct suturing of the pulmonary veins during the repair of congenital cardiac malformations. Post-operative imaging is routinely performed by echocardiography but cardiovascular magnetic resonance (CMR) offers excellent anatomical imaging and quantitative information about pulmonary blood flow. We sought to compare the diagnostic value of echocardiography and CMR for assessing pulmonary vein anatomy after the APA. METHODS This retrospective study evaluated all consecutive patients between October 1998 and January 2010 after either a primary or secondary APA followed by post-repair CMR. RESULTS Of 103 patients who had an APA, 31 patients had an analyzable CMR study. The average time to CMR was 24.6 ± 32.5 months post-repair. Echocardiographic findings were confirmed by CMR in 12 patients. There was incomplete imaging by echocardiography in 7 patients and underestimation of pulmonary vein restenosis in 12, when compared to CMR. In total, 19/31 patients (61%) from our cohort had significant stenosis following the APA as assessed by CMR. Our data suggest that at least 18% (19/103) of all patients had significant obstruction post-repair. CONCLUSIONS Echocardiography incompletely imaged or underestimated the severity of obstruction in patients compared with CMR. Pulmonary vein stenosis remains a sizable complication after repair, even using the APA.
Collapse
Affiliation(s)
- Steven C Greenway
- Division of Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, M5G 1X8, Canada
| | - Shi-Joon Yoo
- Division of Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, M5G 1X8, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Ontario, M5G 1X8, Canada
| | - Giedrius Baliulis
- Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Ontario, M5G 1X8, Canada
| | - Christopher Caldarone
- Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Ontario, M5G 1X8, Canada
| | - John Coles
- Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Ontario, M5G 1X8, Canada
| | - Lars Grosse-Wortmann
- Division of Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, M5G 1X8, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Ontario, M5G 1X8, Canada
| |
Collapse
|
39
|
Valsangiacomo Buechel ER, Fogel MA. Congenital Cardiac Defects and MR-Guided Planning of Surgery. Magn Reson Imaging Clin N Am 2011; 19:823-40; viii. [DOI: 10.1016/j.mric.2011.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
40
|
Palti Y, Kanter A, Solter E, Schatzberger R, Kronzon I. Pulmonary Doppler signals: a potentially new diagnostic tool. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:940-4. [PMID: 21965055 DOI: 10.1093/ejechocard/jer175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS To overcome the limitations due to ultrasound attenuation by the air in the lungs, in order to study the pulmonary system using an advanced signal processing technology. METHODS AND RESULTS Pulsed spectral Doppler signals were obtained over the chest wall using a signal processing and algorithm package (transthoracic parametric Doppler, TPD, EchoSense Ltd, Haifa, Israel) in conjunction with a non-imaging Doppler device (Viasys Healthcare, Madison, WI, USA) coupled with an electrocardiogram. The signals picked up by a transducer positioned at various locations over the chest wall, were treated for noise, analysed parametrically and displayed in terms of both velocity and power originating from moving ultrasound reflectors. Clear reproducible lung Doppler signals (LDS) were recorded. Up to five bidirectional triangular waves with peak velocities of 20-40 cm/s, that survived the 40 dB/cm attenuation of the lung, were recorded during each cardiac cycle. The first signal coincides with early ventricular systole, the second with late systole, the third and fourth with diastole, and the last with atrial contraction. CONCLUSION LDS originate from different elements and phases of cardiac activity that generate mechanical waves which propagate throughout the lung and are thus expressed in pulsatile changes in ultrasound reflections. While such signals could originate either from pulsatile blood flow or reflections from movement of the blood vessel--alveolar air interface, the experimental evidence points towards the tissue--air interface movements due to vessel expansion as the origin. The LDS can potentially be an important tool for diagnosing and characterizing cardio-pulmonary physiological states and diseases.
Collapse
|
41
|
Ntsinjana HN, Hughes ML, Taylor AM. The role of cardiovascular magnetic resonance in pediatric congenital heart disease. J Cardiovasc Magn Reson 2011; 13:51. [PMID: 21936913 PMCID: PMC3210092 DOI: 10.1186/1532-429x-13-51] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 09/21/2011] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has expanded its role in the diagnosis and management of congenital heart disease (CHD) and acquired heart disease in pediatric patients. Ongoing technological advancements in both data acquisition and data presentation have enabled CMR to be integrated into clinical practice with increasing understanding of the advantages and limitations of the technique by pediatric cardiologists and congenital heart surgeons. Importantly, the combination of exquisite 3D anatomy with physiological data enables CMR to provide a unique perspective for the management of many patients with CHD. Imaging small children with CHD is challenging, and in this article we will review the technical adjustments, imaging protocols and application of CMR in the pediatric population.
Collapse
Affiliation(s)
- Hopewell N Ntsinjana
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Marina L Hughes
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| |
Collapse
|
42
|
Grosse-Wortmann L, Yoo SJ, Solomon M, Macgowan CK, Keshavjee S, Grasemann H. Cardiopulmonary magnetic resonance imaging in children after lung transplantation: preliminary observations. J Heart Lung Transplant 2011; 30:1294-8. [PMID: 21856174 DOI: 10.1016/j.healun.2011.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/22/2011] [Accepted: 07/01/2011] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Lung transplantation carries a guarded prognosis and is burdened by short-term and long-term complications that affect the airway, lungs, and vasculature. In this pilot study we aimed to assess the feasibility of magnetic resonance imaging (MRI) in 8 pediatric patients after lung transplantation. METHODS The 8 patients in the study were aged between 9 and 17 years and were clinically stable. The scan protocol included MR angiography, phase contrast imaging of the pulmonary arteries and veins, ventricular volumetry, lung parenchyma imaging, and lung volumetry. RESULTS This protocol was successfully done in all patients. Lung volumes measured by MRI correlated well with those by body plethysmography (r = 0.83, p = 0.01). Angiography detected caliber differences between the donor and recipient pulmonary arteries in 5 patients. One patient had hemodynamically relevant pulmonary vein stenosis, as evidenced by MR angiography, a reduction in ipsilateral flow, and an abnormal pulmonary venous flow profile. Three patients had mild left (2 patients) or right (1 patient) ventricular systolic dysfunction. One patient had left main bronchus compression, and 3 patients showed varying degrees of pleural thickening. CONCLUSIONS Our preliminary experience suggests that cardiopulmonary MRI is feasible in pediatric lung transplant recipients and that it provides clinically useful information, especially on the vascular and bronchial anastomoses. However, the value of MRI for routine follow-up in pediatric lung transplant patients needs to be determined in a larger cohort.
Collapse
Affiliation(s)
- Lars Grosse-Wortmann
- Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|
43
|
Yildiz CE, Babaoglu K, Korkmaz A, Dursun M, Altun I, Mert M, Guden M, Cetin G. Rare variation in partial anomalous venous drainage in 2 cases: diagnosis, assessment methods, and surgical approach. Heart Surg Forum 2010; 13:E373-5. [PMID: 21169145 DOI: 10.1532/hsf98.20101042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Where pulmonary veins drain and their relationship with an atrial septal defect (ASD) are important. A sinus venosus (high venosum) type of defect is the most common pathology accompanying partial anomalous pulmonary venous connection. Typically, the right superior pulmonary vein and occasionally the middle pulmonary vein drain into the junction of the superior vena cava (SVC) and the right atrium (RA), and a sinus venosus type of ASD usually accompanies these anomalies. In this report, we assess a very rare pathology in which 3 right pulmonary veins (superior, middle, and inferior) drain into the SVC-RA junction with respect to diagnostic methods and in the light of 2 cases involving patients in 2 different age groups.
Collapse
Affiliation(s)
- Cenk Eray Yildiz
- Department of Cardiovascular Surgery, Istanbul University Institute of Cardiology, Istanbul, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Seale AN, Uemura H, Webber SA, Partridge J, Roughton M, Ho SY, McCarthy KP, Jones S, Shaughnessy L, Sunnegardh J, Hanseus K, Berggren H, Johansson S, Rigby ML, Keeton BR, Daubeney PE. Total Anomalous Pulmonary Venous Connection. Circulation 2010; 122:2718-26. [DOI: 10.1161/circulationaha.110.940825] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Late mortality after repair of total anomalous pulmonary venous connection is frequently associated with pulmonary venous obstruction (PVO). We aimed to describe the morphological spectrum of total anomalous pulmonary venous connection and identify risk factors for death and postoperative PVO.
Methods and Results—
We conducted a retrospective, international, collaborative, population-based study involving all 19 pediatric cardiac centers in the United Kingdom, Ireland, and Sweden. All infants with total anomalous pulmonary venous connection born between 1998 and 2004 were identified. Cases with functionally univentricular circulations or atrial isomerism were excluded. All available data and imaging were reviewed. Of 422 live-born cases, 205 (48.6%) had supracardiac, 110 (26.1%) had infracardiac, 67 (15.9%) had cardiac, and 37 (8.8%) had mixed connections. There were 2 cases (0.5%) of common pulmonary vein atresia. Some patients had extremely hypoplastic veins or, rarely, discrete stenosis of the individual veins. Sixty (14.2%) had associated cardiac anomalies. Sixteen died before intervention. Three-year survival for surgically treated patients was 85.2% (95% confidence interval 81.3% to 88.4%). Risk factors for death in multivariable analysis comprised earlier age at surgery, hypoplastic/stenotic pulmonary veins, associated complex cardiac lesions, postoperative pulmonary hypertension, and postoperative PVO. Sixty (14.8%) of the 406 patients undergoing total anomalous pulmonary venous connection repair had postoperative PVO that required reintervention. Three-year survival after initial surgery for patients with postoperative PVO was 58.7% (95% confidence interval 46.2% to 69.2%). Risk factors for postoperative PVO comprised preoperative hypoplastic/stenotic pulmonary veins and absence of a common confluence.
Conclusions—
Preoperative clinical and morphological features are important risk factors for postoperative PVO and survival.
Collapse
Affiliation(s)
- Anna N. Seale
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Hideki Uemura
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Steven A. Webber
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - John Partridge
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Michael Roughton
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Siew Y. Ho
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Karen P. McCarthy
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Sheila Jones
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Lynda Shaughnessy
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Jan Sunnegardh
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Katarina Hanseus
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Hakan Berggren
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Sune Johansson
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Michael L. Rigby
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Barry R. Keeton
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Piers E.F. Daubeney
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | | |
Collapse
|
45
|
Wong DTH, Grosse-Wortmann L, Yoo SJ. Transpleural pulmonary-to-systemic venous collaterals in a case with obstructed scimitar vein. Pediatr Cardiol 2010; 31:1086-8. [PMID: 20508925 DOI: 10.1007/s00246-010-9741-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 05/11/2010] [Indexed: 10/19/2022]
Abstract
Scimitar syndrome is a rare cause of left-to-right shunting. Surgery is indicated for a pulmonary-to-systemic blood flow ratio greater than 1.5:1 and not infrequently is complicated by postoperative obstruction. This report presents a case of scimitar syndrome and reviews how magnetic resonance imaging (MRI) can be used for initial and follow-up assessment of the syndrome with emphasis on suspected pulmonary venous obstruction. Given the potential high incidence of postoperative occlusion, MRI provides hemodynamic and anatomic information for both initial and follow-up assessment of scimitar syndrome. MRI clearly demonstrated transpleural pulmonary-to-systemic venous collaterals draining the obstructed scimitar vein.
Collapse
Affiliation(s)
- Derek T H Wong
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | | | | |
Collapse
|
46
|
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.
Collapse
Affiliation(s)
- Andreas Kumar
- Stephenson CMR Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | | | | |
Collapse
|
47
|
Kasahara H, Aeba R, Tanami Y, Yozu R. Multislice computed tomography is useful for evaluating partial anomalous pulmonary venous connection. J Cardiothorac Surg 2010; 5:40. [PMID: 20482753 PMCID: PMC2907572 DOI: 10.1186/1749-8090-5-40] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 05/18/2010] [Indexed: 11/10/2022] Open
Abstract
Volume-rendered images, derived from multidetector-row computed tomography (MDCT), can facilitate assessment of the morphology of partial anomalous pulmonary venous connection and are thus useful in pre-operative planning to prevent surgical morbidity and assist post-operative evaluations.
Collapse
|
48
|
Babu-Narayan SV. The role of late gadolinium enhancement cardiovascular magnetic resonance in the assessment of congenital and acquired heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2010. [DOI: 10.1016/j.ppedcard.2009.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
49
|
Hughes ML, Muthurangu V, Taylor AM. Cardiovascular MR imaging — Indications, techniques and protocols. PROGRESS IN PEDIATRIC CARDIOLOGY 2010. [DOI: 10.1016/j.ppedcard.2009.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
50
|
Marín Rodríguez C, Alvaro EM, Sánchez Alegre ML, Martín YR, Carrasco JD. [Contrast-enhanced magnetic resonance angiography in congenital heart disease]. RADIOLOGIA 2009; 51:261-72. [PMID: 19457522 DOI: 10.1016/j.rx.2009.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 02/19/2009] [Indexed: 11/26/2022]
Abstract
Contrast-enhanced MR angiography is one of the greatest achievements brought about by advances in body MRI. The noninvasive evaluation of arteries and veins can obviate heart catheterization, the administration of iodinated contrast, and exposure to ionizing radiation in many patients and spare them the risks associated with these factors. These gains are even more important in children with congenital heart disease, who will have to undergo numerous vascular studies in their lifetimes and are more susceptible to the effects of ionizing radiation. Contrast-enhanced MR angiography provides abundant information for diagnosis and postoperative follow-up in these patients, who reach advanced age thanks to advances in medical and surgical treatment and thus receive more and more imaging studies during their lifetimes. In this review, we analyze the contrast-enhanced MR angiography technique in these patients, the problems and precautions related to the use of gadolinium, the indications for the test, and the relevant imaging findings in patients with congenital heart disease.
Collapse
Affiliation(s)
- C Marín Rodríguez
- Sección de Radiología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | | | | | | | | |
Collapse
|