Right Ventricular Outflow Tract Imaging With CT and MRI: Part 1, Morphology

Abstract

A spectrum of conotruncal anomalies with abnormally positioned great arteries may arise from a perturbation of RVOT formation. Complications after surgery are common, and many patients need follow-up imaging for diagnosis and surgical planning. In this regard, the spectrum of diseases, differential diagnoses, and postoperative findings are briefly described. With CT and MRI, the relationship of the RVOT to critical structures, such as the coronary arteries, can be revealed.

Clinical cardiac structural anatomy reconstructed within the cardiac contour using multidetector‐row computed tomography: Atrial septum and ventricular septum

“…a). It corresponds to the ventriculo‐infundibular fold (Saremi et al, ). The area anterosuperior to this notch is the superior basal part of the crest of the muscular ventricular septum, to which we previously referred as the “infundibular portion of the interventricular septum” (Mori et al, ).…”

“…Although several imaging modalities and techniques have been developed to facilitate guidance during these procedures (Hahn et al, ; Chierchia et al, ; Verma et al, ; Osmancik et al, ), understanding the clinical structural anatomy of the atrial septum and ventricular septum is fundamental to performing safe interventions. Detailed knowledge of the macroscopic, histological, and radiological cardiac anatomy around the atrial and ventricular septa is available, based on extensive studies by research pioneers (Soto et al, ; Anderson et al, ; Kim et al, ; Lamers and Moorman, ; Webb et al, ; Asirvatham, ; Farré et al, ; Saremi et al, ). However, from the viewpoint of clinical cardiologists, many questions about the three‐dimensional gross cardiac anatomy remain unresolved.…”

Why do we break one of the first rules of anatomy when describing the components of the heart?

“…Those using tomographic imaging now correctly describe the diaphragmatic portion of the left ventricle as inferior, not “posterior,” as it is described by those retaining the Valentine nomenclature (Cerqueira et al ). Indeed, virtual dissection of computed tomographic datasets is increasingly becoming the gold standard for revealing the smallest details of cardiac anatomy; and such virtual dissection is necessarily performed with the heart located in the thorax in its attitudinally appropriate position (Saremi et al ; Sánchez‐Quintana et al ; Anderson and Mori ; Mori et al , ). The same caveats apply to the use of three‐dimensional echocardiography, which again reveals the details of cardiac anatomy as shown with the heart in its attitudinally correct location (Fagan et al ; Njeim et al ).…”

Imaging Evaluation of Tricuspid Valve: Analysis of Morphology and Function With CT and MRI

“…Most ECG gated or triggered cardiac CTA techniques modified for the right heart examination (i.e., 50% contrast agent and saline chase in routine coronary CTA) can provide good-quality motion-free images of the RV outlet and trabeculated portions. However, the quality may not be high enough to show the details of the RV inlet [9]. This is mainly because of inhomogeneous enhancement of the right atrium and steak ar-tifacts arising from high-attenuation superior vena cava contrast enhancement when mixed with unenhanced blood of the inferior vena cava.…”

“…However, deriving accurate and reliable quantitative data from these images is difficult. Although endoscopic views of the RV including the TV annulus with CT are possible, CT would still be technically limited in showing all TV leaflet positions at a specific time frame of the cardiac cycle [9]. The septal leaflet can be best assessed in four-chamber views (Fig.…”