ECHO 2013 / Cardiac Magnetic Resonance Imaging in the Adult Congenital Patient

Phase Contrast Imaging

Case: MRI Findings

•Mildly dilated RV

–EDV = 218 ml, indexed EDV = 121 ml/m2

•Indexed ESV = 53 ml/m2

•Normal RV EF of 56%

•No RVOT obstruction

QUESTION

Recommendations for pulmonary valve replacement in an asymptomatic patient with tetralogy of Fallot include:

1.RV EDV > 170 ml/m2

2.RV ESV > 90 ml/m2

3.QRS duration > 180 ms

4.All of the above

Pulmonary Valve Replacement

•Therrien et al. AJC 2005

–RV EDV > 170 ml/m2

•Buechel et al. Eur Heart J 2005

–RV EDV > 150 ml/m2

•Oosterhof et al. Circ 2007

–RVEDV > 160 ml/m2

–RV ESV > 82 ml/m2

Pulmonary Valve Replacement

•Frigola et al. Circ 2008

–(RV EDV > 150 ml/m2)

–Age > 17.5 y

•Geva et al. Circ 2010

–(RV EDV > 150 ml/m2)

–RV ESV > 90 ml/m2

–QRS duration > 140 ms

Case: TGA s/p Mustard

•33 year-old man with transposition of the great arteries, s/p Mustard procedure

Case: TGA s/p ASO

•13 year-old boy with transposition of the great arteries, status post arterial switch operation with LeCompte maneuver