Abstract
Cardiovascular magnetic resonance (CMR), where available, contributes to the informed management of patients with congenital heart disease. In contrast to echocardiography, CMR becomes easier as patients grow. It is versatile and gives unrestricted access to the heart and intrathoracic vessels, providing functional and structural information. Its relative strengths are discussed, and examples are given of congenital conditions in which it provides clinically important information. CMR can prevent the need for diagnostic catheterization or expedite intervention if indicated, enabling planned, directed procedures. In our practice, CMR is used for serial follow-up, investigation of altered symptoms or signs, planning of transcatheter or surgical interventions, and for baseline assessment after surgery. As CMR becomes more widely available, it will contribute increasingly to the lifelong management of patients with congenital heart disease.
References and Recommended Reading
Therrien J, Dore A, Gersony W, et al.: Canadian Cardiovascular Society Consensus Conference 2001 update: recommendations for the management of adults with congenital heart disease (parts 1-3). Can J Cardiol 2001, 17:940–959, 1029-1050, and 1135-1158. Invaluable source of support in the management of adult CHD.
Hirsch R, Kilner PJ, Connelly MS, et al.: Diagnosis in adolescents and adults with congenital heart disease. Prospective assessment of individual and combined roles of magnetic resonance imaging and transesophageal echocardiography. Circulation 1994, 90:2937–2951.
De RoosA, Roest AA: Evaluation of congenital heart disease by magnetic resonance imaging. Eur Radiol 2000, 10:2–6.
MRI Safety web site. http://www.mrisafety.com. Accessed January 2003.
University of Pittsburgh Medical Center web site: http:// www.radiology.upmc.edu/MRsafety/. Accessed January 2003.
Mohiaddin RH: Introduction to Cardiovascular MRI. London: Current Medical Literature; 2002.
Manning WJ, Pennell DJ: Cardiovascular Magnetic Resonance. New York: Churchill Livingstone; 2002.
Higgins CB, de Roos A: Cardiovascular MRI and MRA. Philadelphia: Lippincott Williams & Wilkins; 2003.
Lotz J, Meier C, Leppert A, Galanski M: Cardiovascular flow measurement with phase-contrast MR imaging: basic facts and implementation. Radiographics 2002, 22:651–671. Methods, applications, and potential pitfalls of CMR velocity mapping.
Vasaprasanthan GA, Araoz PA, Higgins CB, Reddy GP: Quantification of flow dynamics in congenital heart disease: applications of velocity-encoded cine MR imaging. Radiographics 2002, 22:895–905. Methods, applications, and potential pitfalls of CMR velocity mapping.
Tan RS, Mohiaddin RH: Cardiovascular applications of magnetic resonance flow measurement. Rays 2001, 26:71–91.
Masui T, Kattayama M, Kobayashi S, et al.: Gadoliniumenhanced MR angiography in the evaluation of congenital cardiovascular disease pre- and postoperative states in infants and children. J Magn Reson Imaging 2000, 12:1034–1042.
Spuentrup E, Bornert P, Botnar RM, et al.: Navigator-gated freebreathing three-dimensional balanced fast field echo (True-FISP) coronary magnetic resonance angiography. Invest Radiol 2002, 37:637–642.
Rebergen SA, Chin JGJ, Ottenkamp J, et al.: Pulmonary regurgitation in the late postoperative follow-up of tetralogy of Fallot — volumetric quantitation by nuclear magnetic resonance velocity mapping. Circulation 1993, 88:2257–2266.
Lorenz CH, Walker ES, Morgan VL, et al.: Normal human right and left ventricular mass, systolic function, and gender differences by cine magnetic resonance imaging. J Cardiovasc Magn Reson 1999, 1:7–21.
Lorenz CH, Walker ES, Graham TP Jr., et al.: Right ventricular performance and mass by use of cine MRI late after atrial repair of transposition of the great arteries. Circulation 1995, 92:233–239.
Petersen SE, Voigtlander T, Kreitner KF, et al.: Quantification of shunt volumes in congenital heart diseases using a breathhold MR phase contrast technique--comparison with oximetry. Int J Cardiovasc Imaging 2002, 8:53–60.
Helbeng WA, de RoosA: Clinical applications of cardiac magnetic resonance imaging after repair of tetralogy of Fallot [review]. Pediatr Cardiol 2000, 21:70–79.
Geva T, Greil GF, Marshall AC, et al.: Gadolinium-enhanced 3-dimensional magnetic resonance angiography of pulmonary blood supply in patients with complex pulmonary stenosis or atresia: comparison with x-ray angiography. Circulation 2002, 106:473–478.
Vliegen HW, Meier C, Leppert A, Galanski M: Magnetic resonance imaging to assess the hemodynamic effects of pulmonary valve replacement in adults late after repair of tetralogy of Fallot. Circulation 2002, 106:1703–1707.
Davlouros PA, Kilner PJ, Hornung TS, et al.: Right ventricular function in adults with repaired tetralogy of Fallot assessed with cardiovascular magnetic resonance imaging: detrimental role of right ventricular outflow aneurysms or akinesia and adverse right-to-left ventricular interaction. J Am Coll Cardiol 2002, 40:2044–2052. Measurements of RV and LV function and pulmonary regurgitant fraction in a large series of patients late after repair of tetralogy of Fallot.
Kilner PJ, Sievers B, Meyer GP, Ho SY: Double-chambered right ventricle or sub-infundibular stenosis assessed by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2002, 4:373–379.
Hornung TS, Kilner PJ, Davlouros PA, et al.: Excessive right ventricular hypertrophic response in adults with the mustard procedure for transposition of the great arteries. Am J Cardiol 2002, 90:800–803.
Fogel MA, Hubbard A, Weinberg PM: A simplified approach for assessment of intracardiac baffles and extracardiac conduits in congenital heart surgery with two- and threedimensional magnetic resonance imaging. Am Heart J 2001, 142:1028–1036.
Wu KC: Myocardial perfusion imaging by magnetic resonance imaging. Curr Cardiol Rep 2003, 5:63–68.
Kim RJ, Wu E, Rafael A, et al.: The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 2000, 343:1445–1453.
Kim WY, Danias PG, Stuber M, et al.: Coronary magnetic resonance angiography for the detection of coronary stenoses. N Engl J Med 2001, 345:1863–1869.
Medis website for image processing software. http://www.medis.nl/ Accessed January 2003. Medis (Leiden, The Netherlands) has been supplying software for the viewing and analysis of CMR for several years. It will run on a PC, but only after installation of software by the company.
CMRtools website for image processing software. Accessible at http://vip.doc.ic.ac.uk/cmrtools/index.php. Accessed January 2003. This software is still in development. It allows viewing of still and cine Digital Imaging and Communications in Medicine (DICOM) images on a PC, with ability to measure areas, volumes, and other parameters. An evaluation version, effective for a limited period, can be downloaded for free trial.
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Babu-Narayan, S.V., Kilner, P.J. & Gatzoulis, M.A. When to order cardiovascular magnetic resonance in adults with congenital heart disease. Curr Cardiol Rep 5, 324–330 (2003). https://doi.org/10.1007/s11886-003-0070-8
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DOI: https://doi.org/10.1007/s11886-003-0070-8