MR imaging of double-outlet right ventricle

The role of cardiovascular magnetic resonance in pediatric congenital heart disease

Cardiovascular magnetic resonance (CMR) has expanded its role in the diagnosis and management of congenital heart disease (CHD) and acquired heart disease in pediatric patients. Ongoing technological advancements in both data acquisition and data presentation have enabled CMR to be integrated into clinical practice with increasing understanding of the advantages and limitations of the technique by pediatric cardiologists and congenital heart surgeons. Importantly, the combination of exquisite 3D anatomy with physiological data enables CMR to provide a unique perspective for the management of many patients with CHD. Imaging small children with CHD is challenging, and in this article we will review the technical adjustments, imaging protocols and application of CMR in the pediatric population.

Cardiac MR Imaging and MR Angiography for Assessment of Complex Tetralogy of Fallot and Pulmonary Atresia

Breath-hold electrocardiographically gated cardiac magnetic resonance (MR) imaging and contrast material-enhanced MR angiography are emerging as ideal techniques for the evaluation of complex congenital heart disease. Tetralogy of Fallot is the most common cause of cyanotic congenital heart disease and, in its classic form, is associated with varying degrees of hypoplasia of the central and peripheral pulmonary arteries, with valvar pulmonary atresia and collateral aortopulmonary vessels occupying the extreme end of the spectrum. Accurate assessment of the size and anatomy of the pulmonary arteries is often difficult with echocardiography and conventional cineangiography. Compared with echocardiography in particular, cardiac MR imaging with three-dimensional reconstruction has distinct advantages for pre- or postoperative assessment of pulmonary anatomy in patients with tetralogy of Fallot and pulmonary atresia. MR imaging enables the clear and complete depiction of anatomy and thus can provide additional information about pulmonary artery abnormalities that are difficult to evaluate with conventional cardiac imaging techniques.

Morphologic and functional evaluation of congenital heart disease by magnetic resonance imaging

Magnetic resonance imaging (MRI) has evolved sufficiently to be recognized as a useful complementary noninvasive method to echocardiography in the evaluation of congenital heart disease (CHD). In some cases, MRI is superior to other imaging modalities, particularly in the evaluation of thoracic aortic anomalies and in defining the anatomy of central pulmonary arteries; it is also the procedure of choice in the postoperative follow-up of patients with CHD. Recent technological advances permit not only morphological evaluation (provided by spin-echo and MR angiographic techniques) but functional and flow information (provided by fast cine-GE and velocity-encoded sequences), causing it to be recognized by pediatric cardiologists and cardiac surgeons as an unavoidable technique for pre- and postoperative evaluation of some CHD. This review describes the various techniques used in the evaluation of CHD with emphasis on recent developments as well as recognized clinical applications. J. Magn. Reson. Imaging 1999;10:639-655.

Double outlet right ventricle assessed with magnetic resonance imaging

In this article the value of magnetic resonance (MR) imaging for the evaluation of double outlet right ventricle (DORV) is reviewed from the literature and illustrated with several cases. MR imaging can be used for the determination of cardiac anatomy at initial diagnosis and may provide functional information during the follow-up of patients after surgical correction.

Magnetic resonance imaging--the evaluation of choice in residual shunt after congenital heart disease surgery?

Accurate anatomic diagnosis presents a dilemma in patients with residual shunt after corrective surgery for congenital heart disease. We describe a patient who, after atrial septal defect repair, developed dyspnea and central cyanosis despite normal pulmonary arterial pressures and right heart chamber size. A role for early MRI is suggested.

Evaluation of complex congenital ventricular anomalies with magnetic resonance imaging

Complex ventricular anomalies are frequently associated with abnormalities of thoracic and abdominal situs, arterioventricular connection, and venous connection. The definition of all components of these anomalies is difficult to accomplish with imaging techniques. This study compared the effectiveness of electrocardiographic (ECG) gated spin-echo magnetic resonance imaging (MRI) with cardiac angiography for the evaluation of all components of central cardiovascular anatomy in patients with the clinical diagnosis of single or common ventricle or complete atrioventricular (AV) septal (canal) defect. MRI studies and angiograms of 29 patients were evaluated independently. A sequential approach was used to define cardiac anatomy assessing nine anatomic features in each patient. MRI provided 261 observations and angiography provided 209 observations. In the mutual 209 observations, only 17 discrepancies were found. Comparison of MRI and angiography in individual cases showed that MRI was as effective as angiography in the depiction of ventricular anomalies, including determination of morphology and evaluation of the size of the ventricles, the orientation of the ventricular septum relative to the AV valves, as well as the origins and spatial relationships of the great arteries. MRI was more informative for the determination of thoracic and abdominal situs and systemic and pulmonary venoatrial connections, but was not as effective for the evaluation of semilunar valves. Thus MRI provides complete evaluation of central cardiovascular anatomy and is effective in the anatomic assessment of most components of complex ventricular anomalies.