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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
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2
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Sengupta A, Carreon CK, Gauvreau K, Lee JM, Sanders SP, Colan SD, Del Nido PJ, Mayer JE, Nathan M. Growth of the Neo-Aortic Root and Prognosis of Transposition of the Great Arteries. J Am Coll Cardiol 2024; 83:516-527. [PMID: 37939977 DOI: 10.1016/j.jacc.2023.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Neo-aortic root dilatation can lead to significant late morbidity after the arterial switch operation (ASO) for dextro-transposition of the great arteries (d-TGA). OBJECTIVES We sought to examine the growth of the neo-aortic root in d-TGA. METHODS A single-center, retrospective cohort study of patients who underwent the ASO between July 1, 1981 and September 30, 2022 was performed. Morphology was categorized as dextro-transposition of the great arteries with intact ventricular septum (d-TGA-IVS), dextro-transposition of the great arteries with ventricular septal defect (d-TGA-VSD), and double-outlet right ventricle-transposition of the great arteries type (DORV-TGA). Echocardiographically determined diameters and derived z scores were measured at the annulus, sinus of Valsalva, and sinotubular junction immediately before the ASO and throughout follow-up. Trends in root dimensions over time were assessed using linear mixed-effects models. The association between intrinsic morphology and the composite of moderate-severe aortic regurgitation (AR) and neo-aortic valve or root intervention was evaluated with univariable and multivariable Cox proportional hazards models. RESULTS Of 1,359 patients who underwent the ASO, 593 (44%), 666 (49%), and 100 (7%) patients had d-TGA-IVS, d-TGA-VSD, and DORV-TGA, respectively. Each patient underwent a median of 5 echocardiograms (Q1-Q3: 3-10 echocardiograms) over a median follow-up of 8.6 years (range: 0.1-39.3 years). At 30 years, patients with DORV-TGA demonstrated greater annular (P < 0.001), sinus of Valsalva (P = 0.039), and sinotubular junction (P = 0.041) dilatation relative to patients with d-TGA-IVS. On multivariable analysis, intrinsic anatomy, older age at ASO, at least mild AR at baseline, and high-risk root dilatation were associated with moderate-severe AR and neo-aortic valve or root intervention at late follow-up (all P < 0.05). CONCLUSIONS Longitudinal surveillance of the neo-aortic root is warranted long after the ASO.
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Affiliation(s)
- Aditya Sengupta
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
| | - Chrystalle Katte Carreon
- The Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ji M Lee
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Stephen P Sanders
- The Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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3
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Santens B, Van De Bruaene A, De Meester P, Claessen G, Moons P, Claus P, Goetschalckx K, Bogaert J, Budts W. Decreased cardiac reserve in asymptomatic patients after arterial switch operation for transposition of the great arteries. Int J Cardiol 2023; 388:131153. [PMID: 37433406 DOI: 10.1016/j.ijcard.2023.131153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/13/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Exercise capacity is impaired in patients after arterial switch operation (ASO) for complete transposition of the great arteries. Maximal oxygen consumption is related with outcome. OBJECTIVES This study assessed ventricular function by advanced echocardiography and cardiac magnetic resonance (CMR) imaging at rest and during exercise, to determine exercise capacity in ASO patients, and to correlate exercise capacity with ventricular function as potential early marker of subclinical impairment. METHODS Forty-four patients (71% male, mean age 25 ± 4 years - range 18-40 years) were included during routine clinical follow-up. Assessment involved physical examination, 12‑lead ECG, echocardiography, and cardiopulmonary exercise test (CPET) (day 1). On day 2 CMR imaging at rest and during exercise was performed. Blood was sampled for biomarkers. RESULTS All patients reported New York Heart Association class I, the overall cohort had an impaired exercise capacity (80 ± 14% of predicted peak oxygen consumption). Fragmented QRS was present in 27%. Exercise CMR showed that 20% of patients had abnormal contractile reserve (CR) of the left ventricle (LV) and 25% had reduced CR of the right ventricle (RV). CR LV and CR RV were significantly associated with impaired exercise capacity. Pathological patterns on myocardial delayed enhancement and hinge point fibrosis were detected. Biomarkers were normal. CONCLUSION This study found that in some asymptomatic ASO patients electrical, LV and RV changes at rest, and signs of fibrosis are present. Maximal exercise capacity is impaired and seems to be linearly related to the CR of the LV and the RV. Therefore, exercise CMR might play a role in detecting subclinical deterioration of ASO patients.
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Affiliation(s)
- Béatrice Santens
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Alexander Van De Bruaene
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Pieter De Meester
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Belgium
| | | | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Belgium.
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4
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Engele LJ, van der Palen RLF, Egorova AD, Bartelings MM, Wisse LJ, Glashan CA, Kiès P, Vliegen HW, Hazekamp MG, Mulder BJM, Ruiter MCD, Bouma BJ, Jongbloed MRM. Cardiac Fibrosis and Innervation State in Uncorrected and Corrected Transposition of the Great Arteries: A Postmortem Histological Analysis and Systematic Review. J Cardiovasc Dev Dis 2023; 10:jcdd10040180. [PMID: 37103059 PMCID: PMC10143292 DOI: 10.3390/jcdd10040180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/28/2023] Open
Abstract
In the transposition of the great arteries (TGA), alterations in hemodynamics and oxygen saturation could result in fibrotic remodeling, but histological studies are scarce. We aimed to investigate fibrosis and innervation state in the full spectrum of TGA and correlate findings to clinical literature. Twenty-two human postmortem TGA hearts, including TGA without surgical correction (n = 8), after Mustard/Senning (n = 6), and arterial switch operation (ASO, n = 8), were studied. In newborn uncorrected TGA specimens (1 day-1.5 months), significantly more interstitial fibrosis (8.6% ± 3.0) was observed compared to control hearts (5.4% ± 0.8, p = 0.016). After the Mustard/Senning procedure, the amount of interstitial fibrosis was significantly higher (19.8% ± 5.1, p = 0.002), remarkably more in the subpulmonary left ventricle (LV) than in the systemic right ventricle (RV). In TGA-ASO, an increased amount of fibrosis was found in one adult specimen. The amount of innervation was diminished from 3 days after ASO (0.034% ± 0.017) compared to uncorrected TGA (0.082% ± 0.026, p = 0.036). In conclusion, in these selected postmortem TGA specimens, diffuse interstitial fibrosis was already present in newborn hearts, suggesting that altered oxygen saturations may already impact myocardial structure in the fetal phase. TGA-Mustard/Senning specimens showed diffuse myocardial fibrosis in the systemic RV and, remarkably, in the LV. Post-ASO, decreased uptake of nerve staining was observed, implicating (partial) myocardial denervation after ASO.
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Affiliation(s)
- Leo J Engele
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Centre, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Netherlands Heart Institute, 3511 EP Utrecht, The Netherlands
| | - Roel L F van der Palen
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Pediatric Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Anastasia D Egorova
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Margot M Bartelings
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Anatomy and Embryology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Lambertus J Wisse
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Anatomy and Embryology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Claire A Glashan
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Philippine Kiès
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Hubert W Vliegen
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Mark G Hazekamp
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Cardiothoracic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Barbara J M Mulder
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Centre, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Marco C De Ruiter
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Anatomy and Embryology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Berto J Bouma
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Centre, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Monique R M Jongbloed
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Anatomy and Embryology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Egbe AC, Miranda WR, Stephens EH, Anderson JH, Andi K, Goda A, Abozied O, Ramachandran D, Connolly HM. Right Ventricular Systolic Dysfunction in Adults With Anatomic Repair of d-Transposition of Great Arteries. Am J Cardiol 2023; 192:101-108. [PMID: 36764091 PMCID: PMC10402278 DOI: 10.1016/j.amjcard.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/19/2022] [Accepted: 01/13/2023] [Indexed: 02/10/2023]
Abstract
The purpose of this study was to assess the prevalence of right ventricular (RV) systolic dysfunction in adults with anatomic repair of dextro-transposition of great arteries (d-TGAs), and to determine its relation to clinical outcomes across multiple domains (functional status, peak oxygen consumption, N-terminal pro-brain natriuretic peptide, and heart failure hospitalization). Adults with anatomic repair for d-TGA and with echocardiographic images for strain analysis were divided into 2 groups: (1) d-TGA status after an arterial switch operation (d-TGA-ASO group) and (2) d-TGA status after a Rastelli operation (d-TGA-Rastelli group). RV systolic function was assessed using RV global longitudinal strain (RVGLS), and RV systolic dysfunction was defined as RVGLS >-18%. We identified 151 patients (median age 21 years [19 to 28]; d-TGA-ASO group 89 [59%], and d-TGA-Rastelli group 62 [41%]). The mean RVGLS was -22 ± 4%, and 47 patients (31%) had RV systolic dysfunction. The d-TGA-Rastelli group had lower (less negative) RVGLS than that of the d-TGA-ASO group (-19 ± 3% vs -25 ± 3%, p <0.001) and higher prevalence of RV systolic dysfunction (48% vs 19%, p <0.001). RVGLS (absolute value) was associated with peak oxygen consumption (r = 0.58, p <0.001; adjusted R2 = 0.28), log-N-terminal pro-brain natriuretic peptide (r = -0.41, p = 0.004; adjusted R2 = 0.21), New York Heart Association class III/IV (odds ratio 2.29, 1.56 to 3.19, p = 0.01), and heart failure hospitalization (hazard ratio 0.93, 0.88 to 0.98, p = 0.009). RV systolic dysfunction was common in adults with d-TGA and anatomic repair and was associated with clinical outcomes. Longitudinal studies are required to determine the risk factors for progressive RV systolic dysfunction and to identify strategies for preventing RV systolic dysfunction in this population.
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6
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Tseng SY, Tretter JT, Gao Z, Ollberding NJ, Lang SM. Aortic root rotational position associates with aortic valvar incompetence and aortic dilation after arterial switch operation for transposition of the great arteries. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1013-1021. [PMID: 36809390 DOI: 10.1007/s10554-023-02794-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/02/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Aortic dilation and valvar regurgitation can develop in transposition of the great arteries (TGA) after the arterial switch operation (ASO). Variation in aortic root rotational position affects flow dynamics in patients without congenital heart disease. The aim of this study was to assess neo-aortic root (neo-AoR) rotational position and its association with neo-AoR dilation, ascending aorta (AAo) dilation, and neo-aortic valvar regurgitation in TGA following ASO. METHODS Patients with TGA repaired by ASO who underwent cardiac magnetic resonance (CMR) were reviewed. Neo-AoR rotational angle, neo-AoR and AAo dimensions indexed (to height), indexed left ventricular end diastolic volume (LVEDVI), and neo-aortic valvar regurgitant fraction (RF) were obtained from CMR. RESULTS Among 36 patients, the median age at CMR was 17.1 years (12.3, 21.9). Neo-AoR rotational angle (range - 52 to + 78°) was clockwise ( ≥ + 15°) in 50%, counterclockwise (<-9°) in 25%, and central (-9 to + 14°) in 25% of patients. A quadratic term for neo-AoR rotational angle, indicating increasing extremes of counterclockwise and clockwise angles, was associated with neo-AoR dilation (R2 = 0.132, p = 0.03), AAo dilation (R2 = 0.160, p = 0.016), and LVEDVI (R2 = 0.20, p = 0.007). These associations remained statistically significant on multivariable analyses. Rotational angle was negatively associated with neo-aortic valvar RF on univariable (p < 0.05) and multivariable analyses (p < 0.02). Rotational angle was associated with smaller bilateral branch pulmonary arteries (p = 0.02). CONCLUSION In patients with TGA after ASO, neo-AoR rotational position likely affects valvar function and hemodynamics, leading to a risk of neo-AoR and AAo dilation, aortic valvar incompetence, increasing left ventricular size, and smaller branch pulmonary arteries.
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Affiliation(s)
- Stephanie Y Tseng
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Justin T Tretter
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatric Cardiology, The Heart, Vascular, and Thoracic Institute, Cleveland Clinic Children's, Cleveland Clinic, Cleveland, OH, USA
| | - Zhiqian Gao
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nicholas J Ollberding
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sean M Lang
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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7
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Marelli A, Beauchesne L, Colman J, Ducas R, Grewal J, Keir M, Khairy P, Oechslin E, Therrien J, Vonder Muhll IF, Wald RM, Silversides C, Barron DJ, Benson L, Bernier PL, Horlick E, Ibrahim R, Martucci G, Nair K, Poirier NC, Ross HJ, Baumgartner H, Daniels CJ, Gurvitz M, Roos-Hesselink JW, Kovacs AH, McLeod CJ, Mulder BJ, Warnes CA, Webb GD. Canadian Cardiovascular Society 2022 Guidelines for Cardiovascular Interventions in Adults With Congenital Heart Disease. Can J Cardiol 2022; 38:862-896. [PMID: 35460862 DOI: 10.1016/j.cjca.2022.03.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/15/2022] [Accepted: 03/30/2022] [Indexed: 12/12/2022] Open
Abstract
Interventions in adults with congenital heart disease (ACHD) focus on surgical and percutaneous interventions in light of rapidly evolving ACHD clinical practice. To bring rigour to our process and amplify the cumulative nature of evidence ACHD care we used the ADAPTE process; we systematically adjudicated, updated, and adapted existing guidelines by Canadian, American, and European cardiac societies from 2010 to 2020. We applied this to interventions related to right and left ventricular outflow obstruction, tetralogy of Fallot, coarctation, aortopathy associated with bicuspid aortic valve, atrioventricular canal defects, Ebstein anomaly, complete and congenitally corrected transposition, and patients with the Fontan operation. In addition to tables indexed to evidence, clinical flow diagrams are included for each lesion to facilitate a practical approach to clinical decision-making. Excluded are recommendations for pacemakers, defibrillators, and arrhythmia-directed interventions covered in separate designated documents. Similarly, where overlap occurs with other guidelines for valvular interventions, reference is made to parallel publications. There is a paucity of high-level quality of evidence in the form of randomized clinical trials to support guidelines in ACHD. We accounted for this in the wording of the strength of recommendations put forth by our national and international experts. As data grow on long-term follow-up, we expect that the evidence driving clinical practice will become increasingly granular. These recommendations are meant to be used to guide dialogue between clinicians, interventional cardiologists, surgeons, and patients making complex decisions relative to ACHD interventions.
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Affiliation(s)
- Ariane Marelli
- McGill University Health Centre, Montréal, Québec, Canada.
| | - Luc Beauchesne
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jack Colman
- Toronto Adult Congenital Heart Disease Program, Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robin Ducas
- St. Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jasmine Grewal
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Erwin Oechslin
- Toronto Adult Congenital Heart Disease Program, Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Judith Therrien
- Jewish General Hospital, MAUDE Unit, McGill University, Montréal, Québec, Canada
| | | | - Rachel M Wald
- Toronto Adult Congenital Heart Disease Program, Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Candice Silversides
- Toronto Adult Congenital Heart Disease Program, Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Lee Benson
- The Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada
| | - Pierre-Luc Bernier
- McGill University Health Centre, Montreal Heart Institute, Montréal, Québec, Canada
| | - Eric Horlick
- Toronto Adult Congenital Heart Disease Program, Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Réda Ibrahim
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Krishnakumar Nair
- Toronto Adult Congenital Heart Disease Program, Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nancy C Poirier
- Université de Montréal, CHU-ME Ste-Justine, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Heather J Ross
- Toronto Adult Congenital Heart Disease Program, Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Helmut Baumgartner
- Department of Cardiology III: Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Curt J Daniels
- The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Michelle Gurvitz
- Boston Adult Congenital Heart Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Adrienne H Kovacs
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | | | - Gary D Webb
- Cincinnati Children's Hospital Heart Institute, Cincinnati, Ohio, USA
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8
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the use of cardiovascular magnetic resonance in pediatric congenital and acquired heart disease : Endorsed by The American Heart Association. J Cardiovasc Magn Reson 2022; 24:37. [PMID: 35725473 PMCID: PMC9210755 DOI: 10.1186/s12968-022-00843-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of CMR in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of CMR in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA
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9
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the Use of Cardiac Magnetic Resonance in Pediatric Congenital and Acquired Heart Disease: Endorsed by The American Heart Association. Circ Cardiovasc Imaging 2022; 15:e014415. [PMID: 35727874 PMCID: PMC9213089 DOI: 10.1161/circimaging.122.014415] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cardiovascular magnetic resonance has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of cardiovascular magnetic resonance in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of cardiovascular magnetic resonance in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, (M.A.F.).,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, (M.A.F.)
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA, (S.A.)
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA, (C.B.)
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA, (L.B.)
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA, (T.C.)
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA, (T.J.)
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK, (V.M.)
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA, (M.T.)
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA (C.W.)
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10
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Gordon B, González-Fernández V, Dos-Subirà L. Myocardial fibrosis in congenital heart disease. Front Pediatr 2022; 10:965204. [PMID: 36467466 PMCID: PMC9715985 DOI: 10.3389/fped.2022.965204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/18/2022] [Indexed: 11/21/2022] Open
Abstract
Myocardial fibrosis resulting from the excessive deposition of collagen fibers through the myocardium is a common histopathologic finding in a wide range of cardiovascular diseases, including congenital anomalies. Interstitial fibrosis has been identified as a major cause of myocardial dysfunction since it distorts the normal architecture of the myocardium and impairs the biological function and properties of the interstitium. This review summarizes current knowledge on the mechanisms and detrimental consequences of myocardial fibrosis in heart failure and arrhythmias, discusses the usefulness of available imaging techniques and circulating biomarkers to assess this entity and reviews the current body of evidence regarding myocardial fibrosis in the different subsets of congenital heart diseases with implications in research and treatment.
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Affiliation(s)
- Blanca Gordon
- Integrated Adult Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Santa Creu i Sant Pau University Hospital, Barcelona, Spain
| | - Víctor González-Fernández
- Integrated Adult Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Santa Creu i Sant Pau University Hospital, Barcelona, Spain
| | - Laura Dos-Subirà
- Integrated Adult Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Santa Creu i Sant Pau University Hospital, Barcelona, Spain
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11
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van der Palen RLF, Blom NA, Kuipers IM, Rammeloo LAJ, Jongbloed MRM, Konings TC, Bouma BJ, Koolbergen DR, Hazekamp MG. Long-term outcome after the arterial switch operation: 43 years of experience. Eur J Cardiothorac Surg 2021; 59:968-977. [PMID: 33942860 PMCID: PMC8106945 DOI: 10.1093/ejcts/ezab006] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/16/2020] [Accepted: 12/09/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The objective of this study was to assess our 43-year experience with arterial switch operation (ASO) for transposition of the great arteries (TGA) by analysing cardiac outcome measures (hospital and late mortality, reoperations and catheter interventions, significant coronary artery obstruction) and to identify risk factors for reoperation and catheter interventions. METHODS A total of 490 patients who underwent ASO for TGA from 1977 to 2020 were included in this retrospective, single-centre study. Data on reoperation and catheter intervention of hospital survivors were estimated by the Kaplan-Meier method and compared using a long-rank test. Risk factors for reoperation and/or catheter intervention were assessed by multivariate Cox regression analysis. RESULTS Hospital mortality occurred in 43 patients (8.8%), late death in 12 patients (2.9%) and 43 patients were lost to follow-up. Median follow-up time of 413 hospital survivors was 15.6 (interquartile range 7.0-22.4) years. Reoperations were performed in 83 patients (117 reoperations). Neoaortic valve regurgitation with root dilatation was the second most common indication for reoperation (15/83 patients, 18.1%) after right ventricular outflow tract obstruction (50/83 patients, 60.2%). Risk factors for any reoperation on multivariable analysis were: TGA morphological subtype [TGA with ventricular septal defect: hazard ratio (HR) = 1.99, 95% confidence interval (CI) 1.18-3.36; P = 0.010 and Taussig-Bing: HR = 2.17, 95% CI 1.02-4.64; P = 0.045], aortic arch repair associated with ASO (HR = 3.03, 95% CI 1.62-5.69; P = 0.001) and a non-usual coronary artery anatomy (HR = 2.41, 95% CI 1.45-4.00; P = 0.001). One hundred and one catheter interventions were performed in 54 patients, usually for relief of supravalvular pulmonary stenosis (44/54 patients, 81.5%) or arch obstruction (10/54 patients, 18.5%). Main risk factor for catheter intervention on multivariable analysis was aortic arch repair associated with ASO (HR = 2.95, 95% CI 1.37-6.36; P = 0.006). Significant coronary artery stenosis was relatively uncommon (9/413 patients, 2.2%) but may be underrepresented. CONCLUSIONS Patients after ASO typically have good long-term clinical outcomes but reoperations and interventions remain necessary in some patients. Neoaortic valve regurgitation with root dilatation is the second most common indication for reoperation after right ventricular outflow tract obstruction and an increasing need for neoaortic valve and root redo surgery in future is to be expected.
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Affiliation(s)
- Roel L F van der Palen
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
- Division of Pediatric Cardiology, Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Irene M Kuipers
- Division of Pediatric Cardiology, Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Lukas A J Rammeloo
- Division of Pediatric Cardiology, Department of Pediatrics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Thelma C Konings
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Berto J Bouma
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - David R Koolbergen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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12
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Progresión y predictores de insuficiencia valvular neoaórtica y dilatación de la raíz neoaórtica en adultos jóvenes tras cirugía de switch arterial. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.01.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Sotelo J, Valverde I, Martins D, Bonnet D, Boddaert N, Pushparajan K, Uribe S, Raimondi F. Impact of aortic arch curvature in flow haemodynamics in patients with transposition of the great arteries after arterial switch operation. Eur Heart J Cardiovasc Imaging 2021; 23:402-411. [PMID: 33517430 DOI: 10.1093/ehjci/jeaa416] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/20/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS In this study, we will describe a comprehensive haemodynamic analysis and its relationship to the dilation of the aorta in transposition of the great artery (TGA) patients post-arterial switch operation (ASO) and controls using 4D-flow magnetic resonance imaging (MRI) data. METHODS AND RESULTS Using 4D-flow MRI data of 14 TGA young patients and 8 age-matched normal controls obtained with 1.5 T GE-MR scanner, we evaluate 3D maps of 15 different haemodynamics parameters in six regions; three of them in the aortic root and three of them in the ascending aorta (anterior-left, -right, and posterior for both cases) to find its relationship with the aortic arch curvature and root dilation. Differences between controls and patients were evaluated using Mann-Whitney U test, and the relationship with the curvature was accessed by unpaired t-test. For statistical significance, we consider a P-value of 0.05. The aortic arch curvature was significantly different between patients 46.238 ± 5.581 m-1 and controls 41.066 ± 5.323 m-1. Haemodynamic parameters as wall shear stress circumferential (WSS-C), and eccentricity (ECC), were significantly different between TGA patients and controls in both the root and ascending aorta regions. The distribution of forces along the ascending aorta is highly inhomogeneous in TGA patients. We found that the backward velocity (B-VEL), WSS-C, velocity angle (VEL-A), regurgitation fraction (RF), and ECC are highly correlated with the aortic arch curvature and root dilatation. CONCLUSION We have identified six potential biomarkers (B-VEL, WSS-C, VEL-A, RF, and ECC), which may be helpful for follow-up evaluation and early prediction of aortic root dilatation in this patient population.
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Affiliation(s)
- Julio Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, General Cruz 222, 236-2905 Valparaíso, Chile.,Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Avenida Vicuña Mackenna 4869, Macul, Santiago 832-0000, Chile.,Department of Electrical Engineering, School of Engineering, Pontificia Universidad Católica de Chile, Avenida Vicuña Mackenna 4860, Macul, Santiago 832-0000, Chile.,Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile
| | - Israel Valverde
- School of Biomedical Engineering & Imaging Sciences, King's College London, Lambeth Wing St, Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.,Paediatric Cardiology, Evelina London Children's Hospital, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.,Pediatric Cardiology Unit, Institute of Biomedicine of Seville (IBIS), CIBER-CV, Hospital Virgen de Rocio/CSIC/University of Seville, Av. Manuel Siurot, S/n, 41013 Seville, Spain
| | - Duarte Martins
- Unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes-M3C, Hôpital universitaire Necker-Enfants Malades, 149 Rue de Sèvres, 75015 Paris, France.,Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental. Av. Prof. Dr. Reinaldo dos Santos, 2790-134 Carnaxide, Lisbon, Portugal
| | - Damien Bonnet
- Unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes-M3C, Hôpital universitaire Necker-Enfants Malades, 149 Rue de Sèvres, 75015 Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Unit, Hôpital universitaire Necker-Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - Kuberan Pushparajan
- School of Biomedical Engineering & Imaging Sciences, King's College London, Lambeth Wing St, Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.,Paediatric Cardiology, Evelina London Children's Hospital, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Sergio Uribe
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Avenida Vicuña Mackenna 4869, Macul, Santiago 832-0000, Chile.,Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile.,Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Avda. Libertador Bernando O'Higgins 340, 833-1150 Santiago, Chile
| | - Francesca Raimondi
- Paediatric Cardiology, Evelina London Children's Hospital, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.,Unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes-M3C, Hôpital universitaire Necker-Enfants Malades, 149 Rue de Sèvres, 75015 Paris, France.,Pediatric Radiology Unit, Hôpital universitaire Necker-Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
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14
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Canan A, Ashwath R, Agarwal PP, François C, Rajiah P. Multimodality Imaging of Transposition of the Great Arteries. Radiographics 2021; 41:338-360. [PMID: 33481689 DOI: 10.1148/rg.2021200069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transposition of the great arteries (TGA) is a congenital conotruncal abnormality characterized by discordant connections between the ventricles and great arteries, with the aorta originating from the right ventricle (RV), and the pulmonary artery (PA) originating from the left ventricle (LV). The two main types of TGA are complete transposition or dextro-transposition of the great arteries (D-TGA), commonly referred to as d-loop, and congenitally corrected transposition (CCTGA), commonly referred to as l-loop or L-TGA. In D-TGA, the connections between the ventricles and atria are concordant, whereas in CCTGA they are discordant, with the left atrium connected to the RV, and the right atrium connected to the LV. D-TGA manifests during the neonatal period and can be surgically managed by atrial switch operation (AtrSO), arterial switch operation (ASO), Rastelli procedure, or Nikaidoh procedure. Arrhythmia, systemic ventricular dysfunction, baffle stenosis, and baffle leak are the common complications of AtrSO, whereas supravalvular pulmonary or branch PA stenosis, neoaortic dilatation, and coronary artery narrowing are the common complications of ASO. CCTGA may manifest late in life, even in adulthood. Surgeries for associated lesions such as tricuspid regurgitation, subpulmonic stenosis, and ventricular septal defect may be performed. A double-switch operation that includes both the atrial and arterial switch operations constitutes anatomic correction for CCTGA. Imaging plays an important role in the evaluation of TGA, both before and after surgery, for helping define the anatomy, quantify hemodynamics, and evaluate complications. Transthoracic echocardiography is the first-line imaging modality for presurgical planning in children with TGA. MRI provides comprehensive morphologic and functional information, particularly in adults after surgery. CT is performed when MRI is contraindicated or expected to generate artifacts. The authors review the imaging appearances of TGA, with a focus on pre- and postsurgical imaging. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Arzu Canan
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.); and Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (C.F., P.R.)
| | - Ravi Ashwath
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.); and Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (C.F., P.R.)
| | - Prachi P Agarwal
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.); and Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (C.F., P.R.)
| | - Christopher François
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.); and Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (C.F., P.R.)
| | - Prabhakar Rajiah
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.); and Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (C.F., P.R.)
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15
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Siripornpitak S, Goo HW. CT and MRI for Repaired Complex Adult Congenital Heart Diseases. Korean J Radiol 2020; 22:308-323. [PMID: 33289363 PMCID: PMC7909854 DOI: 10.3348/kjr.2020.0895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/21/2020] [Accepted: 09/01/2020] [Indexed: 12/30/2022] Open
Abstract
An increasing number of adult congenital heart disease (ACHD) patients continue to require life-long diagnostic imaging surveillance using cardiac CT and MRI. These patients typically exhibit a large spectrum of unique anatomical and functional changes resulting from either single- or multi-stage palliation and surgical correction. Radiologists involved in the diagnostic task of monitoring treatment effects and detecting potential complications should be familiar with common cardiac CT and MRI findings observed in patients with repaired complex ACHD. This review article highlights the contemporary role of CT and MRI in three commonly encountered repaired ACHD: repaired tetralogy of Fallot, transposition of the great arteries after arterial switch operation, and functional single ventricle after Fontan operation.
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Affiliation(s)
- Suvipaporn Siripornpitak
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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16
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Leiner T, Bogaert J, Friedrich MG, Mohiaddin R, Muthurangu V, Myerson S, Powell AJ, Raman SV, Pennell DJ. SCMR Position Paper (2020) on clinical indications for cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2020; 22:76. [PMID: 33161900 PMCID: PMC7649060 DOI: 10.1186/s12968-020-00682-4] [Citation(s) in RCA: 149] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 12/22/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) last published its comprehensive expert panel report of clinical indications for CMR in 2004. This new Consensus Panel report brings those indications up to date for 2020 and includes the very substantial increase in scanning techniques, clinical applicability and adoption of CMR worldwide. We have used a nearly identical grading system for indications as in 2004 to ensure comparability with the previous report but have added the presence of randomized controlled trials as evidence for level 1 indications. In addition to the text, tables of the consensus indication levels are included for rapid assimilation and illustrative figures of some key techniques are provided.
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Affiliation(s)
- Tim Leiner
- Department of Radiology, E.01.132, Utrecht University Medical Center, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Catholic University Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
| | - Raad Mohiaddin
- Department of Radiology, Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, South Kensington Campus, London, SW7 2AZ, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Science & Great Ormond Street Hospital for Children, UCL Institute of Cardiovascular, Great Ormond Street, London, WC1N 3JH, UK
| | - Saul Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA
| | - Dudley J Pennell
- Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- Imperial College, South Kensington Campus, London, SW7 2AZ, UK
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17
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Ashton DJ, Greenberg SB. Post Repair Transposition of the Great Arteries: What You Need to Know. Semin Roentgenol 2020; 55:312-319. [PMID: 32859347 DOI: 10.1053/j.ro.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel J Ashton
- Department of Radiology and Department of Pediatrics, Arkansas Children's Hospital/University of Arkansas for Medical Sciences, Little Rock, AR.
| | - S Bruce Greenberg
- Department of Radiology and Department of Pediatrics, Arkansas Children's Hospital/University of Arkansas for Medical Sciences, Little Rock, AR
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18
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Rueda Soriano J, Rodríguez Puras MJ, Buendía Fuentes F, Wals Rodríguez A, Osa Sáez A, Pulido I, Agüero Ramón-Llin J, Manso García B, Insa Albert B, Navarro S, Martínez-Dolz L, Gallego P. Time course and predictors for neoaortic root dilatation and neoaortic valve regurgitation during adult life after arterial switch operation. ACTA ACUST UNITED AC 2020; 74:329-336. [PMID: 32402686 DOI: 10.1016/j.rec.2020.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/31/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES There are limited data on the long-term development of neoaortic root dilatation (NRD) and neoaortic valve regurgitation (AR) after arterial switch operation (ASO) for transposition of the great arteries during adult life. METHODS We performed a retrospective longitudinal analysis of 152 patients older than 15 years who underwent ASO for transposition of the great arteries and who were followed-up for 4.9±3.3 years in 2 referral centers. Sequential changes in body surface-adjusted aortic root dimensions and progression to moderate/severe AR were determined in patients with 2 or more echocardiographic examinations. Risk factors for dilatation were tested by Cox regression to identify predictors of AR progression. RESULTS At baseline, moderate AR was present in 9 patients (5.9%) and severe AR in 4 (2.6%), of whom 3 had required aortic valve surgery. Initially, the median neoaortic root dimension was 20.05±2.4mm/m2, which increased significantly to 20.73±2.8mm/m2 (P <.001) at the end of follow-up. The mean change over time was 0.14mm/m2/y (95%CI, 0.07-0.2). Progressive AR was observed in 20 patients (13.5%) and 6 patients (4%) required aortic valve surgery. Progressive AR was associated with bicuspid valve, AR at baseline, NRD at baseline, and neoaortic root enlargement. Independent predictors were bicuspid valve (HR, 3.3; 95%CI, 1.1-15.2; P=.037), AR at baseline (HR, 5.9; 95%CI, 1.6-59.2; P=.006) and increase in NRD (HR, 4.1 95%CI, 2-13.5; P=.023). CONCLUSIONS In adult life, NRD and AR progress over time after ASO. Predictors of progressive AR are bicuspid valve, AR at baseline, and increase in NRD.
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Affiliation(s)
- Joaquín Rueda Soriano
- Unidad de Cardiopatías Congénitas del Adulto, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, CIBERCV, Valencia, Spain.
| | - María José Rodríguez Puras
- Unidad de Cardiopatías Congénitas del Adulto, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Instituto BioMedicina (IBIS), CIBERCV, Sevilla, Spain
| | - Francisco Buendía Fuentes
- Unidad de Cardiopatías Congénitas del Adulto, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, CIBERCV, Valencia, Spain
| | - Amadeo Wals Rodríguez
- Unidad de Cardiopatías Congénitas del Adulto, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Instituto BioMedicina (IBIS), CIBERCV, Sevilla, Spain
| | - Ana Osa Sáez
- Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, CIBERCV, Valencia, Spain
| | - Ildefonso Pulido
- Unidad de Cardiopatías Congénitas del Adulto, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Jaime Agüero Ramón-Llin
- Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, CIBERCV, Valencia, Spain; Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Begoña Manso García
- Unidad de Cardiopatías Congénitas del Adulto, Sección de Cardiología Pediátrica, Hospital Infantil Virgen del Rocío, Sevilla, Spain
| | - Beatriz Insa Albert
- Sección de Cardiología Pediátrica, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Silvia Navarro
- Unidad de Cardiopatías Congénitas del Adulto, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Luis Martínez-Dolz
- Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, CIBERCV, Valencia, Spain
| | - Pastora Gallego
- Unidad de Cardiopatías Congénitas del Adulto, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Instituto BioMedicina (IBIS), CIBERCV, Sevilla, Spain
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Belhadjer Z, Soulat G, Ladouceur M, Pitocco F, Legendre A, Bonnet D, Iserin L, Mousseaux E. Neopulmonary Outflow Tract Obstruction Assessment by 4D Flow MRI in Adults With Transposition of the Great Arteries After Arterial Switch Operation. J Magn Reson Imaging 2019; 51:1699-1705. [PMID: 31794141 DOI: 10.1002/jmri.27012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/19/2019] [Accepted: 11/19/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The main complication in adult patients with transposition of the great arteries (TGA) treated by an arterial switch operation (ASO) is neopulmonary outflow tract stenosis (NPOTS). However, pulmonary flow velocity measurements cannot always be performed with transthoracic echocardiography (TTE) due to complex anatomical features. 4D flow MRI allows detection, quantification, and location of the obstruction site along the NPOTS. PURPOSE AND HYPOTHESIS To investigate the accuracy of 4D flow for the diagnosis of NPOTS in adults with TGA corrected by ASO. STUDY TYPE Prospective. POPULATION Thirty-three adult patients with TGA treated by ASO (19 men, mean age 25.5 years old). FIELD STRENGTH/SEQUENCE Accelerated 4D flow research sequence at 3T. ASSESSMENT Maximum NPOTS velocities on TTE and 4D flow MRI done the same day. STATISTICAL TESTS Pearson correlation coefficient, paired t-test, and Bland-Altman analysis were used to investigate the relationship between TTE and MRI data. RESULTS In 16 patients (48.5%), evaluation of NPOTS anatomy was not obtained by TTE, while it was always possible by 4D flow. Peak flow velocity (PV) measurements in Doppler and 4D flow were highly correlated (r = 0.78; P < 0.001). PV >350 cm.s-1 was detected in only one patient (3%) by TTE vs. five patients (15%) by 4D flow. Moreover, a high correlation was found between PV and the right ventricle (RV) mass index to body surface area when using 4D flow (r = 0.63; P < 0.001). The location of NPOTS was determined in all patients using 4D flow and concerned the main pulmonary artery in 42%. DATA CONCLUSION Compared to TTE, 4D flow MRI provides better sensitivity to detect and locate NPOTS in patients with TGA treated by ASO. 4D flow PV measurements in NPOTS were well correlated with TTE PV and RV mass. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:1699-1705.
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Affiliation(s)
- Zahra Belhadjer
- PARCC, INSERM 970, F-75015, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Necker enfant malades, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015, Paris, France.,Université de Paris, F-75006, Paris, France
| | - Gilles Soulat
- PARCC, INSERM 970, F-75015, Paris, France.,Université de Paris, F-75006, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
| | - Magalie Ladouceur
- PARCC, INSERM 970, F-75015, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Necker enfant malades, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015, Paris, France.,Université de Paris, F-75006, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
| | | | - Antoine Legendre
- Assistance Publique Hôpitaux de Paris, Hôpital Necker enfant malades, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015, Paris, France.,Université de Paris, F-75006, Paris, France
| | - Damien Bonnet
- Assistance Publique Hôpitaux de Paris, Hôpital Necker enfant malades, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
| | - Laurence Iserin
- Assistance Publique Hôpitaux de Paris, Hôpital Necker enfant malades, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015, Paris, France.,Université de Paris, F-75006, Paris, France
| | - Elie Mousseaux
- PARCC, INSERM 970, F-75015, Paris, France.,Université de Paris, F-75006, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
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20
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Palen RL, Deurvorst QS, Kroft LJ, Boogaard PJ, Hazekamp MG, Blom NA, Lamb HJ, Westenberg JJ, Roest AA. Altered Ascending Aorta Hemodynamics in Patients After Arterial Switch Operation for Transposition of the Great Arteries. J Magn Reson Imaging 2019; 51:1105-1116. [DOI: 10.1002/jmri.26934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Roel L.F. Palen
- Division of Pediatric Cardiology, Department of PediatricsLeiden University Medical Center Leiden The Netherlands
| | - Quirine S. Deurvorst
- Division of Pediatric Cardiology, Department of PediatricsLeiden University Medical Center Leiden The Netherlands
| | - Lucia J.M. Kroft
- Department of RadiologyLeiden University Medical Center Leiden The Netherlands
| | - Pieter J. Boogaard
- Department of RadiologyLeiden University Medical Center Leiden The Netherlands
| | - Mark G. Hazekamp
- Department of Cardiothoracic SurgeryLeiden University Medical Center Leiden The Netherlands
| | - Nico A. Blom
- Division of Pediatric Cardiology, Department of PediatricsLeiden University Medical Center Leiden The Netherlands
| | - Hildo J. Lamb
- Department of RadiologyLeiden University Medical Center Leiden The Netherlands
| | - Jos J.M. Westenberg
- Department of RadiologyLeiden University Medical Center Leiden The Netherlands
| | - Arno A.W. Roest
- Division of Pediatric Cardiology, Department of PediatricsLeiden University Medical Center Leiden The Netherlands
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21
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Loke YH, Capuano F, Mandell J, Cross RR, Cronin I, Mass P, Balaras E, Olivieri LJ. Abnormal Pulmonary Artery Bending Correlates With Increased Right Ventricular Afterload Following the Arterial Switch Operation. World J Pediatr Congenit Heart Surg 2019; 10:572-581. [PMID: 31496415 DOI: 10.1177/2150135119861358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE In transposition of great arteries, increased right ventricular (RV) afterload is observed following arterial switch operation (ASO), which is not always related to pulmonary artery (PA) stenosis. We hypothesize that abnormal PA bending from the Lecompte maneuver may affect RV afterload in the absence of stenosis. Thus, we sought to identify novel measurements of three-dimensional cardiac magnetic resonance (CMR) images of the pulmonary arteries and compare with conventional measurements in their ability to predict RV afterload. METHODS Conventional measurements and novel measurements of the pulmonary arteries were performed using CMR data from 42 ASO patients and 13 age-matched controls. Novel measurements included bending angle, normalized radius of curvature (Rc), and normalized weighted radius of curvature (Rc-w). Right ventricular systolic pressures (as the surrogate for RV afterload) were measured by either recent echocardiogram or cardiac catheterization. RESULTS Conventional measurements of proximal PA size correlated with differential pulmonary blood flow (r = 0.49, P = .001), but not with RV peak systolic pressures (r = -0.26, P = .18). In ASO patients, Rc-w correlated with higher RV systolic pressures (r = -0.57, P = .002). Larger neoaortic areas and rightward bending angles correlated with smaller right pulmonary artery Rc (r = -0.48, P = .001; r = 0.41, P = .01, respectively). Finally, both pulmonary arteries had significantly smaller Rc compared to normal controls. CONCLUSIONS Pulmonary arteries exhibit abnormal bends following ASO that correlate with increased RV afterload, independent of PA stenosis. Future work should focus on clinical and hemodynamic contributions of these shape parameters.
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Affiliation(s)
- Yue-Hin Loke
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Francesco Capuano
- Department of Industrial Engineering, Universita di Napoli Federico II, Naples, Italy
| | - Jason Mandell
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Russell R Cross
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Ileen Cronin
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Paige Mass
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
| | - Elias Balaras
- Department of Mechanical and Aerospace Engineering, George Washington University, Washington, DC, USA
| | - Laura J Olivieri
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA.,Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
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22
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van der Palen RLF, van der Bom T, Dekker A, Tsonaka R, van Geloven N, Kuipers IM, Konings TC, Rammeloo LAJ, Ten Harkel ADJ, Jongbloed MRM, Koolbergen DR, Mulder BJM, Hazekamp MG, Blom NA. Progression of aortic root dilatation and aortic valve regurgitation after the arterial switch operation. Heart 2019; 105:1732-1740. [PMID: 31292191 PMCID: PMC6855793 DOI: 10.1136/heartjnl-2019-315157] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/03/2019] [Accepted: 05/14/2019] [Indexed: 11/29/2022] Open
Abstract
Objective To study neo-aortic growth and the evolution of neo-aortic valve regurgitation (AR) in patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) from newborn to adulthood and to identify patients at risk. Methods Neo-aortic dimensions (annulus/root/sinotubular junction) and neo-aortic valve regurgitation were assessed serially in 345 patients with TGA who underwent ASO between 1977 and 2015. Linear mixed-effect models were used to assess increase of neo-aortic dimensions over time and to identify risk factors for dilatation. Risk factor analysis for AR by using time-dependent Cox regression models. Results After a rapid increase in the first year after ASO and proportional growth in childhood, neo-aortic dimensions continue to increase in adulthood without stabilisation. Annual diameter increase in adulthood was 0.39±0.06, 0.63±0.09 and 0.54±0.11 mm for, respectively, neo-aortic annulus, root and sinotubular junction, all significantly exceeding normal growth. AR continues to develop over time: freedom from AR ≥moderate during the first 25 years post-ASO was 69%. Risk factors for root dilatation were complex TGA anatomy (TGA-ventricular septal defect (VSD), double outlet right ventricle with subpulmonary VSD) and male gender. Risk factors for AR ≥moderate were: complex TGA anatomy and neo-aortic growth. Per millimetre increase in aortic root dimension, there was a 9% increase in the hazard of AR ≥moderate. Bicuspid pulmonary valve did not relate to the presence of root dilatation or AR. Conclusion After ASO, neo-aortic dilatation proceeds beyond childhood and is associated with an increase in AR incidence over time. Careful follow-up of the neo-aortic valve and root function is mandatory, especially in males and in patients with complex TGA anatomy.
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Affiliation(s)
- Roel L F van der Palen
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Teun van der Bom
- Department of Cardiology, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands
| | - Annika Dekker
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Roula Tsonaka
- Department of Biomedical Data Sciences, Section Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Section Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Irene M Kuipers
- Division of Pediatric Cardiology, Department of Pediatrics, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands
| | - Thelma C Konings
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lukas A J Rammeloo
- Division of Pediatric Cardiology, Department of Pediatrics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Arend D J Ten Harkel
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- Department of Anatomy&Embryology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dave R Koolbergen
- Department of Cardiothoracic Surgery, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.,Division of Pediatric Cardiology, Department of Pediatrics, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands
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23
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Choi KH, Sung SC, Kim H, Lee HD, Kim G, Ko H, Byun JH, Lee YS. Does Coronary Reimplantation After Neoaortic Reconstruction Increase Aortic Regurgitation? Pediatr Cardiol 2019; 40:813-819. [PMID: 30778636 DOI: 10.1007/s00246-019-02075-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 09/29/2018] [Indexed: 11/26/2022]
Abstract
Coronary reimplantation after neoaortic reconstruction (CRANR) in the arterial switch operation (ASO) allows easy selection of accurate coronary transfer sites in the distended neoaorta. However, neoaortic valve injury may occur during coronary reimplantation. We determined whether the CRANR procedure increased the incidence of aortic valve regurgitation (AR) after ASO. Between March 1994 and August 2017, 227 patients underwent ASO. Since September 2000 CRANR has been performed on 155 patients and open coronary reimplantation (OCR) on 72. Patients who had undergone aortocoronary flaps procedures (n = 13), had early or late mortality (n = 27), or lacked data (n = 11) were excluded. We enrolled and retrospectively reviewed the medical records of 176 patients who were followed up for postoperative AR: 38 underwent OCR and 138 underwent CRANR. We compared the incidences of early and late postoperative AR in both groups. We defined mild or greater AR as "significant AR." The groups did not differ in body weight at operation, great artery relationship, and coronary artery anatomy. The incidences of significant AR at discharge were 21.1% (8/38) in the OCR group and 16.6% (23/138) in the CRANR group (p = 0.53). The freedom from significant AR at 5 years was 59.9% in the OCR group and 62.4% in the CRANR group with no difference between the two groups (p = 0.73). Moderate AR occurred in one patient in the CRANR group. No surgical intervention was required for the aortic valve in either group. ASO using the CRANR technique did not increase the incidence of postoperative early and late AR.
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Affiliation(s)
- Kwang Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Mulgeum-eup, Yangsan, Gyeongsangnam, 50612, Republic of Korea
| | - Si Chan Sung
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Mulgeum-eup, Yangsan, Gyeongsangnam, 50612, Republic of Korea.
| | - Hyungtae Kim
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Mulgeum-eup, Yangsan, Gyeongsangnam, 50612, Republic of Korea
| | - Hyoung Doo Lee
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Geena Kim
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hoon Ko
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Joung-Hee Byun
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Young Seok Lee
- Department of Pediatrics, Dong-A University Hospital, Busan, South Korea
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24
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Martins D, Khraiche D, Legendre A, Boddaert N, Raisky O, Bonnet D, Raimondi F. Aortic angle is associated with neo-aortic root dilatation and regurgitation following arterial switch operation. Int J Cardiol 2019; 280:53-56. [DOI: 10.1016/j.ijcard.2019.01.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 11/26/2018] [Accepted: 01/10/2019] [Indexed: 01/17/2023]
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25
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Feasibility of Transthoracic Echocardiography Evaluation of Pulmonary Arteries Following Arterial Switch Operation. Pediatr Cardiol 2018; 39:1523-1529. [PMID: 29882188 DOI: 10.1007/s00246-018-1924-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/06/2018] [Indexed: 01/28/2023]
Abstract
Pulmonary artery (PA) stenosis is the most common late sequela following arterial switch for d-transposition of the great arteries. The purpose of this study was to assess the effectiveness of transthoracic echocardiography in evaluating the pulmonary arteries following repair. This was a retrospective, cross-sectional analysis of all echocardiograms performed on patients following arterial switch operation. A numerical scoring system was devised and used to quantify PA visualization based on 2D images, color mapping, and spectral Doppler. The study cohort included 150 patients. The ability to visualize at least one PA was poorer in patients who were older [> 10 years (47%) vs ≤ 10 years (89%) (p < 0.001)], and who had larger body surface area (BSA) (> 1.25 m2 (40%) vs ≤ 1.25 m2 (90%) (p < 0.001)]. Regardless of age, 2D visualization of the pulmonary arteries was poor for the entire cohort. Of those with at least one non-visualized PA, only 54% had alternative imaging performed or ordered within the 5 years at or prior to their last echocardiogram. In conclusion, PA visualization following arterial switch is worse in patients who are older and in those with larger BSA. In such patients, alternative forms of imaging are more likely to be necessary.
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26
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Di Salvo G, Miller O, Babu Narayan S, Li W, Budts W, Valsangiacomo Buechel ER, Frigiola A, van den Bosch AE, Bonello B, Mertens L, Hussain T, Parish V, Habib G, Edvardsen T, Geva T, Baumgartner H, Gatzoulis MA, Delgado V, Haugaa KH, Lancellotti P, Flachskampf F, Cardim N, Gerber B, Masci PG, Donal E, Gimelli A, Muraru D, Cosyns B. Imaging the adult with congenital heart disease: a multimodality imaging approach—position paper from the EACVI. Eur Heart J Cardiovasc Imaging 2018; 19:1077-1098. [DOI: 10.1093/ehjci/jey102] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 06/28/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Giovanni Di Salvo
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK
| | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK
| | - Sonya Babu Narayan
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK
| | - Wei Li
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK
| | - Werner Budts
- Department Cardiovascular Sciences (KU Leuven), Congenital and Structural Cardiology (CSC UZ Leuven), Leuven, Belgium
| | | | - Alessandra Frigiola
- Adult Congenital Heart Disease, Guy's and St Thomas' Hospital, Westminster Bridge Road, London, UK
| | | | - Beatrice Bonello
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, UK
| | - Luc Mertens
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, SickKids, 555 University Avenue Toronto, Ontario, Canada
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Departments of Paediatrics, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | | | - Gilbert Habib
- APHM, La Timone Hospital, Cardiology Department, Boulevard Jean Moulin, Marseille, France
| | - Thor Edvardsen
- Department of Cardiology, Sognsvannsveien 20, Oslo, Norvegia
| | - Tal Geva
- Department of Cardiology, 300 Longwood Avenue, Farley, Boston, Massachusetts, USA
| | | | - Michael A Gatzoulis
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK
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27
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Broda CR, Shugh SB, Parikh RB, Wang Y, Schlingmann TR, Noel CV. Post-operative Assessment of the Arterial Switch Operation: A Comparison of Magnetic Resonance Imaging and Echocardiography. Pediatr Cardiol 2018; 39:1036-1041. [PMID: 29564521 DOI: 10.1007/s00246-018-1858-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/03/2018] [Indexed: 11/25/2022]
Abstract
After an arterial switch operation (ASO), serial imaging is necessary to monitor for maladaptive changes. We compared cardiac magnetic resonance imaging (CMR) to 2-D transthoracic echocardiography (TTE) in assessing post-operative ASO patients. We performed a retrospective review of patients at a single tertiary care center who underwent an ASO and subsequently had a CMR performed from 7/2010 to 7/2016. Those with single ventricle anatomy, congenitally corrected transposition of the great arteries, or previous atrial switch operation were excluded. TTE obtained within 6 months of the CMR was used for comparison. Parameters compared included ventricular size and systolic function, semilunar valve regurgitation, neo-aortic root dimension, and the presence of branch pulmonary artery (PA) stenosis (on CMR by the Nakata index or right/left flow differential; on TTE by peak velocity > 2 m/s or PA diameter Z score < - 2). Forty-seven patients with 90 CMR and 86 TTE studies met inclusion criteria. CMR and TTE assessment of right ventricular (RV) and left ventricular function did not statistically differ. RV dilation was overdetected by TTE (p = 0.046). Right pulmonary artery and left pulmonary artery (LPA) visualization by TTE was worse than CMR (p < 0.01). There was no statistically significant difference between CMR and TTE assessment of branch PA stenosis; however, there was poor agreement between the use of Z score and velocity when determining branch PA stenosis by TTE (κ < 0). Assessment of neo-pulmonary regurgitation (PR) and neo-aortic regurgitation (AR) was significantly different between CMR and TTE (p < 0.05). Assessment for delayed enhancement was performed in 18% of CMR studies (n = 16), with perfusion defects appreciated in three patients. Substantial differences between CMR and TTE exist when examining the post-operative ASO patient. CMR was superior for evaluation of the branch PAs, which commonly require re-intervention. TTE failed to recognize altered ventricular function in several cases. Differences between TTE and CMR could alter management is some cases. Incorporation of CMR into the routine surveillance of patients who received an ASO is warranted.
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Affiliation(s)
- Christopher R Broda
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin St. MC 19345C, Houston, TX, 77030, USA
| | - Svetlana B Shugh
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin St. MC 19345C, Houston, TX, 77030, USA
| | - Rohan B Parikh
- Department of Internal Medicine, Western Reserve Health Education, Youngstown, OH, USA
| | - YunFei Wang
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin St. MC 19345C, Houston, TX, 77030, USA
| | - Tobias R Schlingmann
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin St. MC 19345C, Houston, TX, 77030, USA
| | - Cory V Noel
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin St. MC 19345C, Houston, TX, 77030, USA.
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28
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Advanced Cardiovascular Magnetic Resonance Techniques in Grown-Up Congenital Heart Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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29
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Di Salvo G, Bulbul Z, Pergola V, Issa Z, Siblini G, Muhanna N, Galzerano D, Fadel B, Al Joufan M, Al Fayyadh M, Al Halees Z. Gothic aortic arch and cardiac mechanics in young patients after arterial switch operation for d-transposition of the great arteries. Int J Cardiol 2017; 241:163-167. [DOI: 10.1016/j.ijcard.2017.03.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/09/2017] [Indexed: 12/18/2022]
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Abstract
PURPOSE OF REVIEW Patients with complete and congenitally corrected transposition of the great arteries commonly survive into adulthood and present with a vast array of clinical residua. RECENT FINDINGS Echocardiography remains the primary imaging modality in the routine assessment of the adult with transposition of the great arteries. It provides a comprehensive anatomic and hemodynamic evaluation. Limitations to echocardiography include evaluation of the following: the systemic right ventricle, baffle patency following atrial switch procedure, coronary arteries following arterial switch procedure or Nikadoh, and multilevel right ventricular outflow tract obstruction. SUMMARY Each form of palliation for transposition of the great arteries results in unique long-term sequelae that affect outcomes. A multimodality approach to imaging is required for a complete evaluation.
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31
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Ghonim S, Voges I, Gatehouse PD, Keegan J, Gatzoulis MA, Kilner PJ, Babu-Narayan SV. Myocardial Architecture, Mechanics, and Fibrosis in Congenital Heart Disease. Front Cardiovasc Med 2017; 4:30. [PMID: 28589126 PMCID: PMC5440586 DOI: 10.3389/fcvm.2017.00030] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/28/2017] [Indexed: 01/15/2023] Open
Abstract
Congenital heart disease (CHD) is the most common category of birth defect, affecting 1% of the population and requiring cardiovascular surgery in the first months of life in many patients. Due to advances in congenital cardiovascular surgery and patient management, most children with CHD now survive into adulthood. However, residual and postoperative defects are common resulting in abnormal hemodynamics, which may interact further with scar formation related to surgical procedures. Cardiovascular magnetic resonance (CMR) has become an important diagnostic imaging modality in the long-term management of CHD patients. It is the gold standard technique to assess ventricular volumes and systolic function. Besides this, advanced CMR techniques allow the acquisition of more detailed information about myocardial architecture, ventricular mechanics, and fibrosis. The left ventricle (LV) and right ventricle have unique myocardial architecture that underpins their mechanics; however, this becomes disorganized under conditions of volume and pressure overload. CMR diffusion tensor imaging is able to interrogate non-invasively the principal alignments of microstructures in the left ventricular wall. Myocardial tissue tagging (displacement encoding using stimulated echoes) and feature tracking are CMR techniques that can be used to examine the deformation and strain of the myocardium in CHD, whereas 3D feature tracking can assess the twisting motion of the LV chamber. Late gadolinium enhancement imaging and more recently T1 mapping can help in detecting fibrotic myocardial changes and evolve our understanding of the pathophysiology of CHD patients. This review not only gives an overview about available or emerging CMR techniques for assessing myocardial mechanics and fibrosis but it also describes their clinical value and how they can be used to detect abnormalities in myocardial architecture and mechanics in CHD patients.
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Affiliation(s)
- Sarah Ghonim
- Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Inga Voges
- Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Peter D. Gatehouse
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Jennifer Keegan
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Michael A. Gatzoulis
- Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Philip J. Kilner
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Sonya V. Babu-Narayan
- Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
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32
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Latus H, Voges I. Quantitative Tissue Characterization in Pediatric Cardiology. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9405-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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33
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de Roos A. Role of Cardiovascular Magnetic Resonance Imaging in Postoperative Follow-Up After the Arterial Switch Operation for Transposition of the Great Arteries. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005463. [DOI: 10.1161/circimaging.116.005463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Albert de Roos
- From the Department of Radiology, Leiden University Medical Center, The Netherlands
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