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Crean A, Benson L, Shah A, Han K, Lesser J, McCrindle BW. Imaging the delayed complications of childhood Kawasaki disease. F1000Res 2022; 11:147. [PMID: 36970577 PMCID: PMC10036956 DOI: 10.12688/f1000research.73097.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/20/2022] Open
Abstract
This review will discuss the long-term complications of Kawasaki disease with a particular focus on imaging surveillance of the coronary arteries in adolescence and adult life. The relative advantages and disadvantages of each modality will be illustrated with practical examples, demonstrating that, in many cases, a multimodality imaging strategy may be required.
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Affiliation(s)
- Andrew Crean
- Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y 4W7, Canada
| | - Lee Benson
- Cardiology, Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Ashish Shah
- Cardiology, St Boniface Hospital, Winnipeg, Manitoba, R2H 2A6, Canada
| | - Kelly Han
- Cardiology, Children's Minnesota Hospital, Minneapolis, MN, 55404, USA
| | - John Lesser
- Cardiology, Minneapolis Heart Institute, Minneapolis, MN, 55407, USA
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Scannell CM, Hasaneen H, Greil G, Hussain T, Razavi R, Lee J, Pushparajah K, Duong P, Chiribiri A. Automated Quantitative Stress Perfusion Cardiac Magnetic Resonance in Pediatric Patients. Front Pediatr 2021; 9:699497. [PMID: 34540764 PMCID: PMC8446614 DOI: 10.3389/fped.2021.699497] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Myocardial ischemia occurs in pediatrics, as a result of both congenital and acquired heart diseases, and can lead to further adverse cardiac events if untreated. The aim of this work is to assess the feasibility of fully automated, high resolution, quantitative stress myocardial perfusion cardiac magnetic resonance (CMR) in a cohort of pediatric patients and to evaluate its agreement with the coronary anatomical status of the patients. Methods: Fourteen pediatric patients, with 16 scans, who underwent dual-bolus stress perfusion CMR were retrospectively analyzed. All patients also had anatomical coronary assessment with either CMR, CT, or X-ray angiography. The perfusion CMR images were automatically processed and quantified using an analysis pipeline previously developed in adults. Results: Automated perfusion quantification was successful in 15/16 cases. The coronary perfusion territories supplied by vessels affected by a medium/large aneurysm or stenosis (according to the AHA guidelines), induced by Kawasaki disease, an anomalous origin, or interarterial course had significantly reduced myocardial blood flow (MBF) (median (interquartile range), 1.26 (1.05, 1.67) ml/min/g) as compared to territories supplied by unaffected coronaries [2.57 (2.02, 2.69) ml/min/g, p < 0.001] and territories supplied by vessels with a small aneurysm [2.52 (2.45, 2.83) ml/min/g, p = 0.002]. Conclusion: Automatic CMR-derived MBF quantification is feasible in pediatric patients, and the technology could be potentially used for objective non-invasive assessment of ischemia in children with congenital and acquired heart diseases.
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Affiliation(s)
- Cian M. Scannell
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Hadeer Hasaneen
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Gerald Greil
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Jack Lee
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Phuoc Duong
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, United Kingdom
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Mao R, Coe JY, Minhas K, Florescu O, Tymchak W, Schantz D, Buffo I, Soni R, Hyman J, Pepelassis D. OCT: A Modality for Identifying Stent Failure in Pediatric Patients With Angiographically Silent Coronary Arteries. JACC Case Rep 2021; 3:849-852. [PMID: 34317640 PMCID: PMC8311378 DOI: 10.1016/j.jaccas.2021.04.027] [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: 12/16/2020] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
We present the case of a 16-year-old patient with anomalous left coronary artery from the left pulmonary artery requiring percutaneous coronary intervention in infancy who presented with ventricular fibrillation arrest. A coronary angiogram revealed 40% narrowing of the stent relative to the remainder of the left main coronary artery. Optical coherence tomography was performed and revealed an area stenosis of 70% relative to the native left main coronary artery. The patient had outgrown the stent. (Level of Difficulty: Advanced.)
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Key Words
- ACE, angiotensin-converting enzyme
- ALCAPA
- ALCAPA, with anomalous left coronary artery from the left pulmonary artery
- CMR, cardiac magnetic resonance
- DES, drug-eluting stent
- ECG, electrocardiogram
- LMCA, left main coronary artery
- LV, left ventricular
- MLA, minimum lumen area
- OCT
- OCT, optical coherence tomography
- PCI
- PCI, percutaneous coronary intervention
- TTE, transthoracic echocardiography
- long-term survival
- outgrown stent
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Affiliation(s)
- Ruochen Mao
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - James-Yashu Coe
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Kunal Minhas
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Oana Florescu
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Wayne Tymchak
- Section of Cardiology, Department of Internal Medicine, University of Alberta, Edmonton, Canada
| | - Daryl Schantz
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada.,Variety Children's Heart Centre, Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Ilan Buffo
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada.,Variety Children's Heart Centre, Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Reeni Soni
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada.,Variety Children's Heart Centre, Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Jeff Hyman
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Dionysios Pepelassis
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada.,Variety Children's Heart Centre, Department of Pediatrics, University of Manitoba, Winnipeg, Canada
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Ntsinjana HN, Tann O, Hughes M, Derrick G, Secinaro A, Schievano S, Muthurangu V, Taylor AM. Utility of adenosine stress perfusion CMR to assess paediatric coronary artery disease. Eur Heart J Cardiovasc Imaging 2018; 18:898-905. [PMID: 27461210 DOI: 10.1093/ehjci/jew151] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/28/2016] [Indexed: 12/30/2022] Open
Abstract
Aims Cardiovascular magnetic resonance (CMR), using adenosine stress perfusion and late-gadolinium enhancement (LGE), is becoming the 'gold standard' non-invasive imaging modality in the assessment of adults with coronary artery disease (CAD). However, despite its proved feasibility in paediatric patients, clinical utility has not been demonstrated. Therefore, this study aims to establish the role of adenosine stress perfusion CMR as a screening test in paediatric patients with acquired or congenital CAD. Methods and results A total of 58 paediatric patients underwent 61 consecutive clinically indicated coronary artery assessments for diagnostic and clinical decision-making purposes. The diagnosis was based on X-ray or computed tomography coronary angiography for anatomy, adenosine stress CMR imaging for myocardial perfusion and LGE for tissue characterization. Two studies were aborted because of unwanted side effects of adenosine stress, thus 59 studies were completed in 56 patients [median age 14.1 years (interquartile range 10.9-16.2)]. When compared with coronary anatomical imaging, adenosine stress perfusion CMR performed as follows: sensitivity 100% (95% confidence interval, CI: 71.6-100%), specificity 98% (95% CI: 86.7-99.9%), positive predictive value (PPV) 92.9% (95% CI: 64.2-99.6%), and negative predictive value 100% (95% CI: 89.9-100%). Conclusion In paediatric CAD, adenosine stress perfusion CMR imaging is adequate as an initial, non-invasive screening test for the identification of significant coronary artery lesions, with anatomical imaging used to confirm the extent of the culprit lesion.
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Affiliation(s)
- Hopewell N Ntsinjana
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK.,Deparetment of Paediatrics, Paediatric Cardiology Division, CH Baragwanath Academic Hospital and University of the Wiwatersrand, Johannesburg, South Africa
| | - Oliver Tann
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Marina Hughes
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Graham Derrick
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Aurelio Secinaro
- Department of Imaging, Bambino Gesù Children's Hospital, Rome, Italy
| | - Silvia Schievano
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
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Crean AM, Ahmed F, Motwani M. The Role of Radionuclide Imaging in Congenital Heart Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9434-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Burchill LJ, Huang J, Tretter JT, Khan AM, Crean AM, Veldtman GR, Kaul S, Broberg CS. Noninvasive Imaging in Adult Congenital Heart Disease. Circ Res 2017; 120:995-1014. [DOI: 10.1161/circresaha.116.308983] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 11/16/2022]
Abstract
Multimodality cardiovascular imaging plays a central role in caring for patients with congenital heart disease (CHD). CHD clinicians and scientists are interested not only in cardiac morphology but also in the maladaptive ventricular responses and extracellular changes predisposing to adverse outcomes in this population. Expertise in the applications, strengths, and pitfalls of these cardiovascular imaging techniques as they relate to CHD is essential. The purpose of this article is to provide an overview of cardiovascular imaging in CHD. We focus on the role of 3 widely used noninvasive imaging techniques in CHD—echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography. Consideration is given to the common goals of cardiac imaging in CHD, including assessment of structural and residual heart disease before and after surgery, quantification of ventricular volume and function, stress imaging, shunt quantification, and tissue characterization. Extracardiac imaging is highlighted as an increasingly important aspect of CHD care.
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Affiliation(s)
- Luke J. Burchill
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Jennifer Huang
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Justin T. Tretter
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Abigail M. Khan
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Andrew M. Crean
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Gruschen R. Veldtman
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Sanjiv Kaul
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Craig S. Broberg
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
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Keir M, Wald RM, Roche SL, Oechslin EN, Horlick E, Osten MD, Benson LN, Hickey EJ, Crean AM. Does a dedicated subspecialty ACHD coronary clinic result in greater consistency in approach and reduced loss to follow-up? An evaluation of the first 3years of the Toronto Congenital Coronary Clinic for Adults. PROGRESS IN PEDIATRIC CARDIOLOGY 2015. [DOI: 10.1016/j.ppedcard.2015.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tobler D, Motwani M, Wald RM, Roche SL, Verocai F, Iwanochko RM, Greenwood JP, Oechslin EN, Crean AM. Evaluation of a comprehensive cardiovascular magnetic resonance protocol in young adults late after the arterial switch operation for d-transposition of the great arteries. J Cardiovasc Magn Reson 2014; 16:98. [PMID: 25497205 PMCID: PMC4263214 DOI: 10.1186/s12968-014-0098-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 11/14/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND In adults with prior arterial switch operation (ASO) for d-transposition of the great arteries, the need for routine coronary artery assessment and evaluation for silent myocardial ischemia is not well defined. In this observational study we aimed to determine the value of a comprehensive cardiovascular magnetic resonance (CMR) protocol for the detection of coronary problems in adults with prior ASO for d-transposition of the great arteries. METHODS Adult ASO patients (≥18 years of age) were recruited consecutively. Patients underwent a comprehensive stress perfusion CMR protocol that included measurement of biventricular systolic function, myocardial scar burden, coronary ostial assessment and myocardial perfusion during vasodilator stress by perfusion CMR. Single photon emission computed tomography (SPECT) was performed on the same day as a confirmatory second imaging modality. Stress studies were visually assessed for perfusion defects (qualitative analysis). Additionally, myocardial blood flow was quantitatively analysed from mid-ventricular perfusion CMR images. In unclear cases, CT coronary angiography or conventional angiography was done. RESULTS Twenty-seven adult ASO patients (mean age 23 years, 85% male, 67% with a usual coronary pattern; none with a prior coronary artery complication) were included in the study. CMR stress perfusion was normal in all 27 patients with no evidence of inducible perfusion defects. In 24 cases the coronary ostia could conclusively be demonstrated to be normal. There was disagreement between CMR and SPECT for visually-assessed perfusion defects in 54% of patients with most disagreement due to false positive SPECT. CONCLUSIONS Adult ASO survivors in this study had no CMR evidence of myocardial ischemia, scar or coronary ostial abnormality. Compared to SPECT, CMR provides additional valuable information about the coronary artery anatomy. The data shows that the asymptomatic and clinically stable adult ASO patient has a low pre-test probability for inducible ischemia. In this situation it is likely that routine evaluation with stress CMR is unnecessary.
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Affiliation(s)
- Daniel Tobler
- />Toronto Congenital Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, 585 University Avenue, 5 N-525, Toronto, ON M5G 2N2 Canada
- />Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Manish Motwani
- />Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
| | - Rachel M Wald
- />Toronto Congenital Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, 585 University Avenue, 5 N-525, Toronto, ON M5G 2N2 Canada
- />Department of Medical Imaging, Toronto General Hospital, Toronto, Canada
| | - Susan L Roche
- />Toronto Congenital Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, 585 University Avenue, 5 N-525, Toronto, ON M5G 2N2 Canada
| | - Flavia Verocai
- />Department of Medical Imaging, Toronto General Hospital, Toronto, Canada
| | - Robert M Iwanochko
- />Department of Medical Imaging, Toronto General Hospital, Toronto, Canada
| | - John P Greenwood
- />Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
| | - Erwin N Oechslin
- />Toronto Congenital Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, 585 University Avenue, 5 N-525, Toronto, ON M5G 2N2 Canada
| | - Andrew M Crean
- />Toronto Congenital Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, 585 University Avenue, 5 N-525, Toronto, ON M5G 2N2 Canada
- />Department of Medical Imaging, Toronto General Hospital, Toronto, Canada
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