ECHO 2013 / Cardiac Magnetic Resonance Imaging in the Adult Congenital Patient
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Surgical Options
•VSD closure with LV-to-PA conduit
•“Double switch” procedure with Mustard and Rastelli procedures (and possible pacemaker)
•Heart transplantation
Summary
•Stents are not a contraindication for CMR
(but most pacemakers are)
•Echocardiography is generally better than CMR for pressure assessment
•Stroke volumes may be assessed by both bright blood (cine) imaging and phase contrast velocity imaging
Summary
•The reproducibility of measurements for the
RV is good, but not as good as for the LV
–Threshold of 20 ml/m2 for different observers and 15 ml/m2 for same observer
•Recommendations for pulmonary valve replacement in an asymptomatic patient with tetralogy of Fallot
–RV EDV > 170 ml/m2 (some groups use 150)
–RV ESV > 90 ml/m2 (some groups use 82)
Thank You 
CMR RV Volumes
|
RV EDV |
RV iEDV |
RV ESV |
SV |
EF |
|
|
(ml) |
(ml/m2) |
(ml) |
(ml) |
(%) |
|
Observer 1 |
258 |
196 |
129 |
128 |
49.8 |
|
Reading 1 |
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Observer 1 |
267 |
202 |
152 |
114 |
42.7 |
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Reading 2 |
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Observer 2 |
251 |
190 |
137 |
114 |
45.4 |
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MASS6 |
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Observer 2 |
268 |
203 |
135 |
133 |
49.8 |
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ReportCard |
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Case: TGA s/p Senning
•19 yr old man with TGA, s/p Senning, asymptomatic
•Mild obstruction of the SVC pathway with mildly dilated (decompressing) azygos vein
•Mild-to-moderate tricuspid regurgitation (RF 2429%) with moderate RV dilation (141 ml/m2)
•RV EF 25%, LV EF 50%
Atrial Switch Baffle Pathways
SVC Pathway
IVC Pathway
TGA/IVS, s/p Senning
Image courtesy of Dr. Tal Geva
Drawing from yorksandhumber hearts.nhs.uk
TGA/IVS, s/p Senning
Image courtesy of Dr. Tal Geva
Drawing from yorksandhumber hearts.nhs.uk
Atrial Switch Baffle Pathways
SVC Pathway
IVC Pathway