The "Cooing Pigeon": TAVI for Acute Aortic Regurgitation Secondary to Homograft Degeneration.

We present a case of acute aortic homograft regurgitation manifesting as a new-onset "cooing" murmur in a patient with congenital heart disease who did not have signs of clinical decompensation or evidence of infective endocarditis. He underwent successful transcatheter aortic valve implantation following a diagnosis of sterile acute valvular degeneration. ().

Comprehensive MRI assessment of the cardiovascular responses to food ingestion in Fontan physiology.

In univentricular (Fontan) physiology, peripheral and splanchnic vascular tone may be raised to counteract reduced cardiac output (CO) and elevated central venous pressure and thus maintain vital organ perfusion. This could negatively affect the normal cardiovascular response to food ingestion, where mesenteric vasodilation and a concurrent rise in CO are central. We sought to elucidate this using rapid cardiovascular MRI.

Cardiovascular imaging in Turner syndrome: state-of-the-art practice across the lifespan.

Cardiovascular imaging is essential to providing excellent clinical care for girls and women with Turner syndrome (TS). Congenital and acquired cardiovascular diseases are leading causes of the lifelong increased risk of premature death in TS. Non-invasive cardiovascular imaging is crucial for timely diagnosis and treatment planning, and a systematic and targeted imaging approach should combine echocardiography, cardiovascular magnetic resonance and, in select cases, cardiac CT.

Idiopathic pulmonary arterial hypertension with coexisting CHD.

Sinus venosus atrial septal defect can result in an increase in pulmonary blood flow and vascular resistance, leading to pulmonary hypertension. Rarely, the degree of pulmonary hypertension is out of proportion to the degree of intra-cardiac shunting. This case outlines the differences between pulmonary hypertension secondary to CHD and idiopathic pulmonary hypertension, and illustrates the investigation and management strategy used in a patient with features of both.

Isolated aortic root dilation in homocystinuria.

Background: Vascular complications in homocystinuria have been known for many years, but there have been no reports to date on involvement of the ascending aorta.

Methods: We conducted a cross-sectional study of patients with homocystinuria, known to a single metabolic centre, and evaluated in 2016 with a transthoracic echocardiogram. Aortic root dilation was defined as Z-score ≥ 2.

Abnormal Wave Reflections and Left Ventricular Hypertrophy Late After Coarctation of the Aorta Repair.

Patients with repaired coarctation of the aorta are thought to have increased afterload due to abnormalities in vessel structure and function. We have developed a novel cardiovascular magnetic resonance protocol that allows assessment of central hemodynamics, including central aortic systolic blood pressure, resistance, total arterial compliance, pulse wave velocity, and wave reflections. The main study aims were to (1) characterize group differences in central aortic systolic blood pressure and peripheral systolic blood pressure, (2) comprehensively evaluate afterload (including wave reflections) in the 2 groups, and (3) identify possible biomarkers among covariates associated with elevated left ventricular mass (LVM).

Magnetic Resonance-Augmented Cardiopulmonary Exercise Testing: Comprehensively Assessing Exercise Intolerance in Children With Cardiovascular Disease.

Background: Conventional cardiopulmonary exercise testing can objectively measure exercise intolerance but cannot provide comprehensive evaluation of physiology. This requires additional assessment of cardiac output and arteriovenous oxygen content difference. We developed magnetic resonance (MR)-augmented cardiopulmonary exercise testing to achieve this goal and assessed children with right heart disease.

Radiofrequency ablation of atrial tachyarrhythmias in adults with tetralogy of Fallot - predictors of success and outcome.

Background: Adults with tetralogy of Fallot experience atrial tachyarrhythmias; however, there are a few data on the outcomes of radiofrequency ablation. We examined the characteristics, outcome, and predictors of recurrence of atrial tachyarrhythmias after radiofrequency ablation in tetralogy of Fallot patients. Methods/results Retrospective data were collected from 2004 to 2013.

Free breathing contrast-enhanced time-resolved magnetic resonance angiography in pediatric and adult congenital heart disease.

Background: Contrast enhanced magnetic resonance angiography (MRA) is generally performed during a long breath-hold (BH), limiting its utility in infants and small children. This study proposes a free-breathing (FB) time resolved MRA (TRA) technique for use in pediatric and adult congenital heart disease (CHD).

Methods: A TRA sequence was developed by combining spiral trajectories with sensitivity encoding (SENSE, x4 kx-ky and x2 kz) and partial Fourier (75% in kz).

MR augmented cardiopulmonary exercise testing-a novel approach to assessing cardiovascular function.

The purposes of this study were: (1) to evaluate feasibility and acceptability of MRI augmented cardiopulmonary exercise testing (MR-CPET) in healthy adults and (2) to test whether peak values obtained at conventional and MR-CPET correlate and to demonstrate variation in peak oxygen consumption (VO2) relates to both peak cardiac output (CO) and peak oxygen extraction (ΔcO2). Seventeen healthy adults underwent CPET and MR-CPET using an MR compatible ergometer and CPET system customised for MR use. Continuous aortic flow measurement used a validated UNFOLD-SENSE spiral phase contrast magnetic resonance (PCMR) sequence.

Real-time magnetic resonance assessment of septal curvature accurately tracks acute hemodynamic changes in pediatric pulmonary hypertension.

Background: This study assesses the relationship between septal curvature and mean pulmonary artery pressure and indexed pulmonary vascular resistance in children with pulmonary hypertension. We hypothesized that septal curvature could be used to estimate right ventricular afterload and track acute changes in pulmonary hemodynamics.

Methods And Results: Fifty patients with a median age of 6.

Clinical issues and outcomes in adults following repair of tetralogy of fallot.

Advances in diagnosis, perioperative and surgical management of neonates born with Tetralogy of Fallot (TOF) have meant that affected individuals can now expect to survive to adulthood. However, this success is counterbalanced by the development of late morbidity in adulthood affecting survival and functional capacity. This review article addresses some of the major sequelae of TOF repair and discusses the contemporary approaches to reduce morbidity and mortality in this population.

Prognostic significance of cardiac magnetic resonance imaging in children with pulmonary hypertension.

Background: There are very few validated prognostic markers in pediatric pulmonary hypertension. Cardiac MRI is a useful, noninvasive method for determining prognosis in adults. The present study is the first to assess its prognostic value in children.

Real-time flow with fast GPU reconstruction for continuous assessment of cardiac output.

Purpose: To demonstrate the feasibility of real-time phase contrast magnetic resonance (PCMR) assessment of continuous cardiac output with a heterogeneous (CPU/GPU) system for online image reconstruction.

Materials And Methods: Twenty healthy volunteers underwent aortic flow examination during exercise using a real-time spiral PCMR sequence. Acquired data were reconstructed in online fashion using an iterative sensitivity encoding (SENSE) algorithm implemented on an external computer equipped with a GPU card.

High-resolution slice-selective Fourier velocity encoding in congenital heart disease using spiral SENSE with velocity unwrap.

Quantification of peak velocity is important in the assessment of stenotic flow jets in patients with congenital heart disease. Phase-contrast magnetic resonance underestimates peak velocities. Hence, clinically Doppler ultrasound is used as the reference standard for assessing stenoses.