A prospective audit of paediatric cardiac MRI under general anaesthesia; practise and problems

Abstract

Journal of Cardiovascular Magnetic Resonance 2009, 11(Suppl 1):O1Introduction: Prophylactic implantation of a cardioverter/ defibrillator (ICD) has been shown to reduce mortality in patients with chronic myocardial infarction (CMI) and an increased risk for life threatening ventricular arrhythmia (VA). The use of ICDs in this large patient population is still limited by high costs and possible adverse events including inappropriate discharges and progression of heart failure. VA is related to infarct size and seems to be related to infarct morphology. Contrast enhanced cardiovascular magnetic resonance imaging (ceCMR) can detect and quantify myocardial fibrosis in the setting of CMI and might therefore be a valuable tool for a more accurate risk stratification in this setting. Hypothesis: ceCMR can identify the subgroup developing VA in patients with prophylactic ICD implantation following MADIT criteria. Methods: We prospectively enrolled 52 patients (49 males, age 69 ± 10 years) with CMI and clinical indication for ICD therapy following MADIT criteria. Prior to implantation (36 ± 78 days) patients were investigated on a 1.5 T clinical scanner (Siemens Avanto © , Germany) to assess left ventricular function (LVEF), LV end-diastolic volume (LVEDV) and LV mass (sequence parameters: GRE SSFP, matrix 256 × 192, short axis stack; full LV coverage, no gap; slice thickness 6 mm). For quantitative assessment of infarct morphology late gadolinium enhancement (LGE) was performed including measurement of total and relative infarct mass (related to LV mass) and the degree of transmurality (DT) as defined by the percentage of transmurality in each scar. (sequence parameters: inversion recovery gradient echo; matrix 256 × 148, imaging 10 min after 0.2 μg/kg gadolinium DTPA; slice orientation equal to SSFP). MRI images were analysed using dedicated software (MASS © , Medis,

Cardiovascular Magnetic Resonance from Fetal to Adult Life—Indications and Challenges: A State-of-the-Art Review

“…An expert and trained anaesthetic team need to be involved with MRI safe equipment (blood pressure and heart rate monitor, electrocardiogram, pulse oximetry, pump infusion, expired gas concentration), and specific hemodynamic and imaging issues need to be discussed prior to each case. Prolonged and multiple breath-hold sequences are usually required and careful ventilation control is important to avoid hypoxia and hypercapnia [44]. This practise varies in different centres depending on local policy, but generally, children less than seven years of age or older with learning disabilities will have CMR performed under general anaesthesia.…”

The Role of Cardiovascular Magnetic Resonance in Pediatric Congenital Heart Disease

“…Prior to each case there is detailed discussion between the anesthetic and cardiac imaging teams, regarding the specific hemodynamic and imaging issues pertaining to the case. With these considerations, our unit and others, have a very good safety profile for imaging these complex patients [ 15 , 16 ].…”