Cardiac Magnetic Resonance Imaging After Stage I Norwood Operation for Hypoplastic Left Heart Syndrome

Muthurangu, Vivek; Taylor, Andrew M.; Hegde, Sanjeet; Johnson, Robert; Tulloh, Robert; Simpson, John; Qureshi, Shakeel; Rosenthal, Éric; Baker, Edward J.; Anderson, David; Razavi, Reza

doi:10.1161/circulationaha.105.543686

Cited by 81 publications

(53 citation statements)

References 31 publications

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“…Gadolinium-enhanced MR angiography was performed as previously described11 with a coronal 3D fast-field-echo sequence. Gadolinium (Dotarem, Guerbet) was injected into a peripheral vein and tracked into the heart with a dynamic coronal 2D fast-field-echo sequence.…”

Section: Methodsmentioning

confidence: 99%

Systemic to pulmonary collateral blood flow influences early outcomes following the total cavopulmonary connection

Odenwald

Quail

Giardini

et al. 2012

Heart

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Section: Methodsmentioning

confidence: 99%

Systemic to pulmonary collateral blood flow influences early outcomes following the total cavopulmonary connection

Odenwald

Quail

Giardini

et al. 2012

Heart

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“…[13][14][15][16] Therefore, this noninvasive imaging modality can potentially provide an alternative to prebidirectional Glenn catheterization; indeed 1 retrospective cohort study demonstrated the feasibility of this approach. 17 The goal of this prospective, randomized, single-center trial of CMR versus catheterization in infants presenting for bidirectional Glenn operation was to test the hypothesis that CMR can provide the necessary anatomic and functional information required to evaluate such patients safely with fewer adverse events, reduced costs, and equivalent short-term postoperative outcomes.…”

Section: Clinical Perspective P 2725mentioning

confidence: 99%

Cardiac Magnetic Resonance Versus Routine Cardiac Catheterization Before Bidirectional Glenn Anastomosis in Infants With Functional Single Ventricle

et al. 2007

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Background— Routine preoperative catheterization is standard practice in patients with single-ventricle physiology before bidirectional Glenn anastomosis. Because catheterization is invasive and exposes patients to ionizing radiation, cardiac magnetic resonance (CMR) may be a safe and effective alternative. Methods and Results— We conducted a prospective, randomized, single-center clinical trial comparing catheterization with CMR in patients considered for bidirectional Glenn operation from February 2003 to June 2006. End points were frequency of adverse events of the preoperative evaluation and a composite score of clinically successful surgery. Of 92 eligible patients, 82 were enrolled on the basis of screening echocardiogram, fulfillment of inclusion criteria, and informed consent. Patients were randomized to catheterization (n=41) or CMR (n=41). There were no baseline differences between groups. Four treatment crossovers occurred, 3 to catheterization and 1 to CMR. Catheter interventions were performed in 17 patients (41%). Catheterization resulted in more minor adverse events (78% versus 5%; P <0.001), longer preoperative hospital stays (median, 2 versus 1 day; P <0.001), and higher hospital charges ($34 477 versus $14 921; P <0.001). There was 1 major adverse event in the CMR group ( P =1.0). The operative course and frequency of postoperative complications were similar between the 2 groups. The proportion of patients who had a successful bidirectional Glenn operation was similar (71% versus 83%; P =0.3). At the 3-month follow-up, there were no differences in clinical status, oxygen saturation, or frequency of reinterventions. Conclusions— CMR is a safe, effective, and less costly alternative to routine catheterization in the evaluation of selected patients before bidirectional Glenn operation. Further studies are necessary to determine whether there are long-term benefits from transcatheter interventions in these patients.

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“…Although not evaluated in this study, other studies have shown that cardiac MRI accurately and adequately visualizes anatomic details including mediastinal vessels such as the aortic arch, branch pulmonary arteries, and large systemic-to-pulmonary collateral vessels in patients with congenital heart disease [10–13, 22, 27, 29]. Its preoperative use could, therefore, show additional anatomic abnormalities missed by echocardiography and significantly reduce the need for anatomic assessment by catheterization.…”

Section: Discussionmentioning

confidence: 87%

What is the Clinical Utility of Routine Cardiac Catheterization Before a Fontan Operation?

et al. 2010

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Patients with single-ventricle circulation presenting for Fontan completion routinely undergo cardiac catheterization despite ongoing debate concerning its additive value. Increasing interest in noninvasive preoperative evaluation alone led the authors to analyze the utility of routine pre-Fontan catheterization and to determine whether a subset of patients could avoid this invasive procedure. Patients younger than 5 years referred for pre-Fontan evaluation were retrospectively reviewed. Medical records and catheter angiograms were examined, and catheterizations were categorized as “additive” based on predetermined criteria. Associations between precatheterization variables, catheterization findings, and short-term postoperative outcomes were evaluated. Cardiac catheterization was clinically nonadditive for 89 of 175 patients undergoing pre-Fontan evaluation (51%). There were no robust precatheterization predictors of a nonadditive catheterization. Echocardiography did not fully demonstrate the relevant anatomy of 115 patients (66%), most frequently due to inadequate visualization of the pulmonary arteries, and 22 patients had additive catheterizations due to new diagnostic findings alone. Interventions at catheterization were frequent and deemed “important” for 64 patients (37%). Catheterization hemodynamic data were not associated with early postoperative outcomes. Minor catheterization complications occurred for 51 patients (29%) and major complications for 4 patients (2%). Although at least 50% of the patients presenting for Fontan completion may be able to avoid routine catheterization safely, an echocardiography-based imaging strategy alone is insufficient to allow proper identification of those who could be evaluated noninvasively. A more comprehensive imaging strategy not based solely on echocardiography should be considered.

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Cardiac Magnetic Resonance Imaging After Stage I Norwood Operation for Hypoplastic Left Heart Syndrome

Cited by 81 publications

References 31 publications

Systemic to pulmonary collateral blood flow influences early outcomes following the total cavopulmonary connection

Systemic to pulmonary collateral blood flow influences early outcomes following the total cavopulmonary connection

Cardiac Magnetic Resonance Versus Routine Cardiac Catheterization Before Bidirectional Glenn Anastomosis in Infants With Functional Single Ventricle

What is the Clinical Utility of Routine Cardiac Catheterization Before a Fontan Operation?

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