ECHO 2013 / Cardiac Magnetic Resonance Imaging in the Adult Congenital Patient
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Cardiac Magnetic Resonance
Imaging in the Adult Congenital
Patient
Wyman W. Lai, MD, MPH
State-of-the-Art ECHO
April 5, 2013
Disclosure
Relevant Financial Relationship
None
Off Label Usage
Gadolinium-based contrast agents in magnetic resonance angiography
CMR in Adult CHD
•Program Description
•CMR Technique
•Reproducibility
•Other Strengths and Limitations
•Cases
CHONY-Columbia CMR Program
•Two GE HDX 1.5T Magnets with dedicated
CMR days
•Two pediatric cardiologists with advanced training and one adult cardiac radiologist
•Congenital CMR Database 2005-10
–1781 studies
–579 patients (33%) > 21 years of age
–181 patients (10%) < 1 year of age
Indications
200 consecutive adult patients 2009-10
Diagnosis |
n |
|
|
Tetralogy of Fallot |
59 (30%) |
|
|
Aorta |
41 (21%) |
-Coarctation (25), Dilation (12), AS/AR (4) |
|
|
|
D-Transposition of the Great Arteries |
20 (10%) |
-s/p Mustard or Senning (13), s/p Rastelli (7) |
|
|
|
Other “Complex” 2V Repair |
38 (19%) |
-s/p Ross (8), PS/PR (8), L-TGA (8), Ebstein (6), PA’s (3), |
|
DORV (3), Truncus Arteriosus (2) |
|
|
|
“Simple” shunt |
16 (8%) |
-Pulmonary Veins (7), ASD (6), VSD (2), PDA (1) |
|
|
|
Single Ventricle |
13 (7%) |
-Tricuspid Atresia (5), PA/IVS (5), other SV (3) |
|
|
|
Suspected Cardiomyopathy |
8 (4%) |
|
|
Other |
5 (3%) |
-PHTN (4), Absent Pericardium (1) |
|
|
|
CMR in Adult CHD
•Program Description
•CMR Technique
•Reproducibility
•Other Strengths and Limitations
•Cases
QUESTION
The presence of a stent is a contraindication for cardiac MR imaging.
1.True
2.False
•Non-gated bright blood (SSFP) axial image with susceptibility artifact
•Black blood (fast spin-echo with DIR)
•Gadolinium-enhanced MRA
•Helical CT axial image without contrast
•Helical CT axial image with contrast
QUESTION
Cardiac MR is better than echocardiography and CT for the assessment of pressure gradients in a patient with a ventricular septal defect.
1.True
2.False