Myocardial perfusion magnetic resonance imaging for detecting coronary function anomalies in asymptomatic paediatric patients with a previous arterial switch operation for the transposition of great arteries

Manso, Begoña; Castellote, Amparo; Dos, Laura; Casaldáliga, Jaume

doi:10.1017/s1047951109990503

Cited by 45 publications

(24 citation statements)

References 45 publications

(70 reference statements)

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“…With such low prevalence, it is not surprising that previous small studies often did not identify evidence of myocardial ischemia. 6,22,30 Furthermore, we found no significant difference between those with and those without LGE with regard to symptoms.…”

Section: Discussioncontrasting

confidence: 65%

“…7 However, despite its established role in congenital cardiac practice, the literature on CMR after the ASO comprises only small case series. 6,21,22 The present study is the first to characterize the range of biventricular size and function, great vessel dimensions, semilunar valve function, and myocardial viability in a large cohort of mostly asymptomatic adolescents and young adult patients followed in a single center in which CMR has been used routinely in this patient group starting in the second decade of life. 23 The reference data presented here can be used to determine how individual patients compare with their peers.…”

Section: Discussionmentioning

confidence: 98%

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Cardiovascular Magnetic Resonance Findings Late After the Arterial Switch Operation

Shepard

Germanakis

White

et al. 2016

Circ: Cardiovascular Imaging

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Because the arterial switch operation (ASO) became the standard treatment for infants and children with D-loop transposition of the great arteries (TGA) in the early-to-mid 1980s, survival has improved with the majority of patients now reaching adulthood.1 Although late mortality is rare, complications involving the implanted coronary arteries, pulmonary arteries, and neoaortic valve and root are increasingly recognized as sources of morbidity.2,3 Although echocardiography is capable of providing much of the clinically relevant information for noninvasive assessment of most ASO patients during infancy and childhood, its ability to adequately assess the key anatomic and functional elements in older patients is hindered by deteriorating acoustic windows.4 Cardiovascular magnetic resonance (CMR) has been shown to be a robust imaging modality in adolescents and adult patients with a wide variety of congenital heart disease, including those after the ASO. 5,6 Specifically, unlike echocardiography, CMR is not hindered by body size and is considered a reliable technique for assessment of the great vessels, biventricular size and function, myocardial viability, and valve regurgitation. See Editorial by de Roos See Clinical PerspectiveAlthough CMR can provide comprehensive anatomic and functional assessment in ASO patients, relatively sparse information has been published to date, and the ranges of ventricular and arterial dimensions and functional parameters have not been characterized. The goal of the present study, therefore, was to describe the range of biventricular size and function, frequency and location of focal myocardial fibrosis evaluated by late gadolinium enhancement (LGE) imaging, spectrum of great vessel dimensions, and frequency and severity of neoaortic valve regurgitation (neo-AR) in a large cohort of ASO patients evaluated at our center. In addition, we sought to explore factors associated with left ventricular (LV) enlargement and dysfunction, as well as neo-AR.Background-Despite its robust diagnostic capabilities in adolescents and adult patients after the arterial switch operation, little information is available on the cardiovascular magnetic resonance findings in this population. Methods and Results-The cardiovascular magnetic resonance findings of 220 consecutive patients evaluated in our center were retrospectively reviewed (median age at cardiovascular magnetic resonance, 15.4 years; 66.8% male sex). Compared with published normal values, left and right ventricular end-diastolic volume z scores were mildly enlarged (0.48±1.76 and 0.33±1.5; P=0.0003 and 0.0038, respectively), with 26% of patients having left ventricular dilatation and 20% having right ventricular dilatation. Left ventricular dysfunction was present in 21.5% of patients (mild in most), and only 5.1% of patients had mild right ventricular dysfunction. Myocardial scar was found in 1.8% of patients. Dilatation of the neoaortic root was common (76%), and root z score increased at an average rate of 0.03 points per year. By multivar...

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Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 98%

Cardiovascular Magnetic Resonance Findings Late After the Arterial Switch Operation

Shepard

Germanakis

White

et al. 2016

Circ: Cardiovascular Imaging

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“…In two reports describing a total of 55 asymptomatic ASO patients who underwent stress perfusion CMR, no defects at stress were detected. 109,110 The LGE technique has identified prior myocardial infarction in only a small proportion of patients after ASO. 73,109,110 Thus, on the basis of these studies, both CMR stress imaging and LGE appear to have a low positive yield in asymptomatic ASO patients.…”

Section: Postoperative Assessment Of Tga With Cmrmentioning

confidence: 99%

“…109,110 The LGE technique has identified prior myocardial infarction in only a small proportion of patients after ASO. 73,109,110 Thus, on the basis of these studies, both CMR stress imaging and LGE appear to have a low positive yield in asymptomatic ASO patients. Larger studies that include symptomatic patients and have longer term follow-up are needed to better define the indications and prognostic value of these CMR techniques.…”

Section: Postoperative Assessment Of Tga With Cmrmentioning

confidence: 99%

Multimodality Imaging Guidelines of Patients with Transposition of the Great Arteries: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography

Cohen

Eidem

Cetta

et al. 2016

Journal of the American Society of Echocardiography

113

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“…Moreover, late gadolinium enhancement may be combined with stress perfusion MR to detect coronary involvement after the ASO in one comprehensive protocol, although the yield seems to be low for detecting myocardial ischemia, and it has been suggested that cardiac MR imaging is not indicated routinely to evaluate possible myocardial ischemic damage in asymptomatic and clinically stable adult patients after the ASO. 7,8 Other vascular sequelae after ASO involve the neopulmonary root and pulmonary artery branches. Pulmonary branch stenosis is seen in two third of patients after the ASO and is the most common reason for reintervention.…”

Section: See Article By Shepard Et Almentioning

confidence: 99%

Role of Cardiovascular Magnetic Resonance Imaging in Postoperative Follow-Up After the Arterial Switch Operation for Transposition of the Great Arteries

Roos

2016

Circ: Cardiovascular Imaging

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C ardiovascular magnetic resonance (MR) plays a major role in the evaluation of patients with transposition of the great arteries, especially during follow-up after surgical intervention such as the arterial switch operation (ASO). It is recommended in recent guidelines that cardiovascular MR should be integrated in the routine evaluation of all postoperative patients with transposition of the great arteries with the frequency dependent on nature of the operation, patient status, and other available clinical data. In some cases, cardiac MR should be considered the primary method for routine noninvasive evaluation with annual or biennial studies. 1 See Article by Shepard et alDuring the ASO, the great arteries are transected, switched, and reanastomosed to the correct ventricle, resulting in a neoaortic root and neopulmonary root with relocation of the pulmonary branches anteriorly to the neoaorta by using the Lecompte manoeuvre, mobilization, and implantation of both coronary arteries in the neoaorta.Several sequelae may occur after ASO that may require long-term follow-up by imaging. First, neoaortic root dilation and subsequent aortic valve regurgitation are widely recognized long-term complications after the ASO and are typically well tolerated hemodynamically. Maladaptation of the former pulmonary artery wall, scarring around surgical suture lines, intrinsic aortic wall abnormalities, and Gothic shape of the aortic arch may promote neoaortic wall stiffening and dilatation, resulting in aortic insufficiency because of loss of coaptation of aortic valve leaflets, contributing to left ventricular hypertrophy and dysfunction.2 Cardiovascular MR studies have shown that enlargement of the neoaortic root is frequently present after arterial switch surgery in conjunction with reduced elasticity of the proximal aorta, mostly minor degrees of aortic regurgitation and reduced left ventricular systolic function.3 In addition, early aortic stiffening in patients after ASO has been recognized as a contributing factor to left atrial enlargement and left ventricular diastolic dysfunction. 4 Other factors may also contribute to early left ventricular dysfunction after ASO, including hypoplastic left anterior descending coronary artery, decreased coronary blood flow reserve, perfusion defects, and altered myocardial architecture. 5 Coronary abnormalities may be found in asymptomatic subjects after ASO in 3% to 7% of the population. MR coronary angiography provides accurate information on coronary anatomy, ostial stenosis, and proximal coronary artery kinking in patients after ASO. 6 Furthermore, late gadolinium enhancement is a useful MR technique to identify myocardial infarcts and viability when coronary occlusion has occurred. Moreover, late gadolinium enhancement may be combined with stress perfusion MR to detect coronary involvement after the ASO in one comprehensive protocol, although the yield seems to be low for detecting myocardial ischemia, and it has been suggested that cardiac MR imaging is not indicated routinely...

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Myocardial perfusion magnetic resonance imaging for detecting coronary function anomalies in asymptomatic paediatric patients with a previous arterial switch operation for the transposition of great arteries

Cited by 45 publications

References 45 publications

Cardiovascular Magnetic Resonance Findings Late After the Arterial Switch Operation

Cardiovascular Magnetic Resonance Findings Late After the Arterial Switch Operation

Multimodality Imaging Guidelines of Patients with Transposition of the Great Arteries: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography

Role of Cardiovascular Magnetic Resonance Imaging in Postoperative Follow-Up After the Arterial Switch Operation for Transposition of the Great Arteries

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