Role of Magnetic Resonance Angiography in the Diagnosis of Major Aortopulmonary Collateral Arteries and Partial Anomalous Pulmonary Venous Drainage

Abstract

Background-Accurate diagnosis of major aortopulmonary collaterals (MAPCAs) and partial anomalous pulmonary venous drainage (PAPVD) in adult patients with congenital heart disease is important but problematic. Threedimensional contrast-enhanced magnetic resonance angiography (MRA) provides a minimally invasive technique to allow detailed studies in a single breath-hold. Methods and Results-We assessed the role of contrast-enhanced 3D MRA in 29 consecutive adult patients with a diagnosis of MAPCAs (nϭ16) or PAPVD (nϭ13) made by echocardiogram, cardiac catheterization, or surgical inspection. MRA was performed with a 3D spoiled gradient-echo technique with intravenous gadolinium-DTPA (0.2 mmol/kg). In both types of pathology, there was excellent correlation between MRA and the cardiac catheterization, echocardiogram, or surgical inspection. Additional information was gained for patients with MAPCAs on confluence and size of pulmonary arteries (nϭ13 had central arteries), pulmonary artery stenosis (nϭ3), aneurysmal dilatation of pulmonary artery (nϭ1), and additional anomalous vascular abnormality (nϭ3). Shunt assessment, where present (9 of 16), showed patency in all cases (100%). For adults with PAPVD, further information was obtained on drainage origin (nϭ11). There were no complications. Conclusions-Contrast-enhanced 3D MRA provides a fast, noninvasive, radiation-free method of accurate and comprehensive diagnosis of MAPCAs and PAPVD in adult patients.

Rare case of Pregnancy with Total Anomalous Pulmonary Venous Connection (TAPVC)

“…X-ray of the chest shows a normal to small heart with fluid in the lungs and Snowman sign or figure of 8 configurations` on chest radiograph . 3,4,5,6 Surgery to repair the abnormal vascular communication is needed as soon as the diagnosis is made in childhood. In surgery, the pulmonary veins are connected to the left atrium and the defect between the right and left atrium is closed.…”

Cardiovascular Magnetic Resonance

“…CMR is valuable and usually superior to echocardiography for the assessment of the pulmonary veins and any anomalies, with flow measurements allowing calculation of the shunt fraction. 27 CMR is often superior to echocardiography after surgical repair, especially for conduits and for the RV, which is often overloaded because it functions as the systemic ventricle or because of pulmonary insufficiency. In transposition of the great arteries, both ventriculoarterial and atrioventricular discordance can be readily identified from spin-echo and cine imaging to characterize the complete or corrected forms.…”

Atrial Septal Defects in the Adult

“…MRI is also excellent at assessing pulmonary venous return. 21 In patients who cannot have an MRI, computed tomographic scanning and angiography can offer similar information.…”