Clinical role, accuracy, and technical aspects of cardiovascular magnetic resonance imaging in infants.

Cardiovascular magnetic resonance imaging (CMRI) has been shown to be an important alternative to echocardiography and catheterization for diagnostic imaging in older patients with congenital heart disease. However, little information is available on its clinical role, accuracy, and technical aspects in infants. We retrospectively identified all patients <1 year of age who underwent a CMRI examination at our institution over a 4-year period (from 1999 to 2002) and reviewed their medical records.

[Predictive factors of Doppler echocardiography in persistent pulmonary artery hypertension of the neonate].

Introduction: echocardiographic evaluation in neonates with persistent pulmonary artery hypertension is often limited to pressure measurements and analysis of pulmonary artery blood flow. The prognostic significance of a more detailed analysis, in particular of the extra-pulmonary shunt, is not known.

Patients And Method: we analysed retrospectively the echocardiographs of neonates with persistent pulmonary artery hypertension who were also entered in a randomised therapeutic trial of treatment with inhaled nitric oxide.

Anaesthesia considerations for cardiac MRI in infants and small children.

Background: General anaesthesia is frequently necessary in infants and small children undergoing cardiac magnetic resonance imaging (MRI), because of the imaging techniques, MRI environment and potential need for breath-holding to facilitate imaging. Anaesthetizing paediatric patients with congenital heart disease (CHD) for cardiac MRI poses many challenges for the anaesthetist and this report reviews our experience.

Methods: We retrospectively reviewed the anaesthesia and MRI records of all patients who had undergone cardiac MRI between January 2000 and October 2002.

Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging.

Objectives: The purpose of this study was to identify independent factors associated with impaired clinical status in late survivors of tetralogy of Fallot (TOF) repair.

Background: Repair of TOF often results in chronic pulmonary regurgitation (PR) and right ventricular (RV) dilation, which have been linked to late morbidity and mortality. However, determinants of clinical status late after TOF repair have not been fully characterized.

Magnetic resonance imaging evaluation of myocardial perfusion and viability in congenital and acquired pediatric heart disease.

This study examined the feasibility and potential clinical utility of magnetic resonance imaging (MRI) evaluation of myocardial perfusion (first-pass contrast enhancement) and viability (myocardial delayed enhancement) in 30 patients with congenital and acquired pediatric heart disease. Good agreement was found between MRI evaluation of myocardial perfusion and viability and analysis of segmental wall motion as well as coronary angiography (n = 10) and single photon emission computed tomography (n = 6).

Respiratory symptoms secondary to aortopulmonary collateral vessels in tetralogy of Fallot absent pulmonary valve syndrome.

Hemodynamically significant systemic-to-pulmonary artery collaterals may represent an underappreciated cause of cardiorespiratory compromise in tetralogy of Fallot with absent pulmonary valve (TOF/APV). We retrospectively reviewed the angiographic, magnetic resonance imaging, operative, and autopsy reports of the 50 patients with TOF/APV managed at our institution in the past 10 years and demonstrated that at least 7 of 50 patients (14%) had significant aortopulmonary collaterals.

Cardiovascular causes of airway compression.

Compression of the paediatric airway is a relatively common and often unrecognized complication of congenital cardiac and aortic arch anomalies. Airway obstruction may be the result of an anomalous relationship between the tracheobronchial tree and vascular structures (producing a vascular ring) or the result of extrinsic compression caused by dilated pulmonary arteries, left atrial enlargement, massive cardiomegaly, or intraluminal bronchial obstruction. A high index of suspicion of mechanical airway compression should be maintained in infants and children with recurrent respiratory difficulties, stridor, wheezing, dysphagia, or apnoea unexplained by other causes.

Cleft mitral valve without ostium primum defect: anatomic data and surgical considerations based on 41 cases.

Background: Cleft mitral valve without an ostium primum defect, referred to as isolated cleft mitral valve, has been the subject of many reports; yet its morphology and operability remain incompletely understood.

Methods: The anatomic findings in 36 postmortem cases, five explanted hearts, and relevant clinical data constitute the material basis of this report. Cardiac catheterization data were available in 29 cases and two-dimensional echocardiograms in 13 cases.

Echocardiographic predictors of aortopulmonary collaterals in infants with tetralogy of fallot and pulmonary atresia.

Objectives: This study was designed to identify echocardiographic predictors of aortopulmonary collaterals (APCs) in infants with tetralogy of Fallot and pulmonary atresia (TOF/PA) and to prospectively validate these predictors.

Background: In patients with TOF/PA, routine preoperative diagnostic cardiac catheterization is usually performed to determine the presence and distribution of APCs and the anatomy of the branch pulmonary arteries.

Methods: The clinical and diagnostic imaging data of infants with TOF/PA treated between 1990 and 2000 were reviewed.

Biatrial or left atrial drainage of the right superior vena cava: anatomic, morphogenetic, and surgical considerations--report of three new cases and literature review.

Since the posterior wall of the right superior vena cava (RSVC) is contiguous with the anterior wall of the right upper pulmonary veins, a localized defect in this common wall may create a cavopulmonary venous confluence without eliminating the normal connection of the same right pulmonary veins with the left atrium (LA). Through this defect, blood of the unroofed right pulmonary veins will drain into the RSVC and right atrium (RA), and blood from the RSVC may shunt into the right pulmonary veins and LA. Hemodynamically, the RSVC will become biatrial.

Use of tissue velocity imaging in the diagnosis of fetal cardiac arrhythmias.

Background: Precise diagnosis of cardiac arrhythmias in the fetus is crucial for a managed therapeutic approach. However, many technical, positional, and gestational age-related limitations may render conventional methods, such as M-mode and Doppler flow methodologies, or newer techniques, such as fetal electrocardiography or magnetocardiography, difficult to apply, or these techniques may be unsuitable for the diagnosis of fetal arrhythmias.

Methods And Results: In this prospective study, we describe a novel method based on raw scan-line tissue velocity data acquisition and analysis.

Gadolinium-enhanced 3-dimensional magnetic resonance angiography of pulmonary blood supply in patients with complex pulmonary stenosis or atresia: comparison with x-ray angiography.

Background: In patients with complex pulmonary stenosis or atresia, a detailed delineation of all sources of pulmonary blood supply is necessary for planning surgical and transcatheter procedures and usually requires diagnostic cardiac catheterization. The goals of this study were to determine whether gadolinium-enhanced 3D magnetic resonance angiography (MRA) can provide a noninvasive alternative to diagnostic catheterization and to compare MRA and x-ray angiography measurements of pulmonary arteries and aortopulmonary collaterals (APCs).

Methods And Results: Thirty-two patients with pulmonary stenosis or atresia (median age: 4.

Repair of ventricular septal defect and left ventricular aneurysm following blunt chest trauma.

In children, even minor trauma to the chest can result in cardiac injury. We describe a case of a 13-year-old boy who received blunt chest trauma during a motorcycle accident. He was initially symptom-free but later complained of persistent chest pain and a murmur was noted.

Adaptive mechanisms of left ventricular diastolic function to the physiologic load of pregnancy.

Background: Pregnancy is associated with marked alteration in cardiovascular hemodynamics. Recent reports have characterized the effects on cardiac systolic function. Little has been written on the influences of loading conditions on Doppler measures of diastolic function during pregnancy.

Cardiac relocation and chest wall reconstruction after separation of thoracopagus conjoined twins with a single heart.

Separation of thoracopagus conjoined twins with a single heart and the twin reversed arterial perfusion sequence yielded a single surviving infant with a protuberant heart covered by ribs and soft tissue from the nonsurviving twin. At 13 months of age, the heart was relocated in the chest after caudal mobilization of the diaphragms. The protective tissue cage was removed and a normal chest contour established.

Coronary magnetic resonance angiography in adolescents and young adults with kawasaki disease.

Background: In patients with Kawasaki disease, serial evaluation of the distribution and size of coronary artery aneurysms (CAA) is necessary for risk stratification and therapeutic management. Although transthoracic echocardiography is often sufficient for this purpose initially, visualization of the coronary arteries becomes progressively more difficult as children grow. We sought to prospectively compare coronary magnetic resonance angiography (MRA) and x-ray coronary angiography findings in patients with CAA caused by Kawasaki disease.

Apical ventricular septal defects: follow-up concerning anatomic and surgical considerations.

Background: Apical ventricular septal defects (VSDs) are difficult to visualize and close transatrially. We described their distinctive anatomic features, which have seldom been documented angiocardiographically and pathologically, in order to develop an effective approach for their surgical management.

Methods: Fourteen postmortem cases, two explanted hearts, 9 successfully operated patients, and 1 unoperated living patient were included in this report.

Effect of acquisition parameters on the accuracy of velocity encoded cine magnetic resonance imaging blood flow measurements.

Purpose: To investigate the effect of acquisition parameters on the accuracy of 2D velocity encoded cine magnetic resonance imaging (VEC MRI) flow measurements.

Materials And Methods: Using a pulsatile flow phantom, through-plane flow measurements were performed on a flexible vessel made of polyvinyl alcohol cryogel (PVA), a material that mimics the MR signal and biomechanical properties of aortic tissue.

Results: Repeated VEC MRI flow measurements (N = 20) under baseline conditions yielded an error of 0.

Gadolinium-enhanced three-dimensional magnetic resonance angiography of pulmonary and systemic venous anomalies.

Objective: The goal of this study was to evaluate the diagnostic value of gadolinium (Gd)-enhanced three-dimensional (3D) magnetic resonance angiography (MRA) in patients with congenital and acquired anomalies of the pulmonary and systemic veins.

Background: Gadolinium-enhanced 3D MRA is a fast magnetic resonance imaging technique that has shown great promise in the evaluation of large and medium-sized arteries. However, its application to venous anomalies has not been studied in detail.

Echocardiographic characteristics and outcome of straddling mitral valve.

Objectives: This study sought to characterize the echocardiographic features of straddling mitral valve (SMV) and to determine its surgical implications and midterm outcome in a large clinical cohort.

Background: Despite a relatively large body of literature on the postmortem anatomy of SMV, there is a paucity of information regarding its echocardiographic features, surgical implications and preoperative predictors of outcome.

Methods: A retrospective review identified 46 patients with SMV between 1982 and 1999 who underwent echocardiography and surgery and had follow-up data.

Predictors of outcome of biventricular repair in infants with multiple left heart obstructive lesions.

Background: Decisions regarding surgical strategy in patients with multiple left heart obstructive or hypoplastic lesions often must be made in the newborn period and are seldom reversible. Predictors of outcome of biventricular repair have not been well defined in this heterogeneous group of patients, and risk factors described for critical aortic valve stenosis have been shown to be inapplicable to patients with other left heart obstructive lesions. The goal of this study was to identify echocardiographic predictors of outcome of biventricular repair for infants with multiple left heart obstructive lesions.