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3-dimensional time-resolved contrast-enhanced magnetic resonance angiography for evaluation late after the Mustard operation for transposition

Published online by Cambridge University Press:  24 November 2009

Bengt Johansson ,
Sonya V. Babu-Narayan ,
Philip J. Kilner ,
Timothy M. Cannell  and
Raad H. Mohiaddin
Bengt Johansson
Affiliation:
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK
Sonya V. Babu-Narayan
Affiliation:
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK
Philip J. Kilner
Affiliation:
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK
Timothy M. Cannell
Affiliation:
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK
Raad H. Mohiaddin*
Affiliation:
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK
*
Correspondence to: Dr Raad H Mohiaddin, Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK. Tel: +44 (0)20-751 8813; Fax: +44 (0)20-751 8816; E-mail: r.mohiaddin@rbht.nhs.uk
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Abstract

Purpose

Cardiovascular magnetic resonance assessment of adults late after an atrial redirection operation for transposition is demanding and time consuming. We hypothesised that the relatively fast and standardised 3-dimensional time-resolved contrast-enhanced magnetic resonance angiography, or dynamic angiography, would be valuable in the periodic follow-up of these patients.

Methods

We investigated prospectively 36 adults with transposition using dynamic angiography, comparing our results against a comprehensive but non-contrast cardiovascular magnetic resonance protocol. We acquired 6 dynamic angiographic datasets after injection of contrast. The primary aim was to detect significant obstruction of the pathways for venous flow.

Results

In 4 patients (11%), we found evidence of moderate-to-severe, and thus clinically important, obstruction of systemic venous channels on standard cardiovascular magnetic resonance. All these patients were correctly identified by dynamic angiography. In 4 additional patients, we found mild and haemodynamically insignificant obstructions in the systemic venous channels. Of the 8 (22%) patients with any obstruction, 6 were detected by angiography. There were no false positives reported, giving sensitivity of 75% and specificity of 100%, a positive predictive value of 100%, and negative predictive value of 93%. In 1 patient, there was a moderate obstruction of the pulmonary venous compartment which was not readily seen by dynamic angiography.

Conclusions

3-dimensional dynamic angiography is a useful method for detecting anatomically moderate-to-severe, but not mild, obstructions in the systemic venous channels following Mustard repair for transposition. This technique can be used as a single imaging method and/or as complimentary to standard two dimensional cardiovascular magnetic resonance techniques for detection of clinically important obstructions in the systemic venous channels.

Keywords

Ventriculo-arterial discordanceadult congenital heart diseaseatrial switchcardiovascular imaging
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 1 , February 2010 , pp. 1 - 7
Copyright
Copyright © Cambridge University Press 2009

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References

1.Senning, Å. Surgical correction of transposition of the great vessels. Surgery 1959; 45: 966–980.Google ScholarPubMed
2.Mustard, WT. Successful two-stage correction of trasnposition of the great vessels. Surgery 1964; 55: 469–472.Google ScholarPubMed
3.Trusler, WG, Williams, WG, Duncan, KF, et al. Results with the Mustard operation in siple transposition of the great arteries 1963–1985. Ann Surg 1987; 206: 251–260.Google Scholar
4.Gelatt, RM, Hamilton, RM, McCrindle, BW, et al. Arrhythmia and mortality after the Mustard procedure: a 30-year single center experience. J Am Coll Cardiol 1997; 29: 194–201.Google Scholar
5.Wilson, NJ, Clarkson, PM, Barratt-Boyes, BG, et al. Long-term follow-up after the Mustard repair for simple transposition of the great arteries. 28-year follow-up. J Am Coll Cardiol 1998; 32: 758–765.Google Scholar
6.Losay, J, Touchot, A, Serraf, A, et al. Late outcome after arterial switch operation for trasposition of the great arteries. Circulation 2001; 104 (12 Suppl 1): I121–I126.CrossRefGoogle Scholar
7.Marelli, AJ, Mackie, AS, Ionescu-Ittu, R, et al. Congenital heart disease in the general population: Changing prevalence and age distribution. Circulation 2007; 115: 163–172.Google Scholar
8.Therrien, J. Echocardiography. In: Gatzoulis, MA, Webb, GD, Daubeney, PEF, eds. Diagnosis and management of adult congenital heart disease. Edinburgh: Churchill Livingstone, 2003; 35–47.Google Scholar
9.Sampson, C, Kilner, PJ, Hirsch, R, et al. Venoatrial pathways after the Mustard operation for transposition of the great arteries: anatomic and functional MR imaging. Radiology 1994; 193: 211–217.CrossRefGoogle ScholarPubMed
10.Dorfman, AL, Geva, T. Magnetic resonance imaging evaluation of congenital heart disease: conotruncal anomalies. J Cardiovasc Magn Reson 2006; 8: 645–659.Google Scholar
11.Fenchel, M, Saleh, R, Dinh, H, et al. Juvenile and adult cogenital heart disease: time-resolved 3D contrast-enhanced MR angiography. Radiology 2007; 244: 399–410.Google Scholar
12.Goo, H, Yang, D, Park, I, et al. Time-resolved three-dimensional contrast-enhanced magnetic resonance angiography in patients who have undergone a Fontan operation or bidirectional cavopulmonary connection:initial experience. J Magn Reson Imaging 2007; 25: 727–736.CrossRefGoogle ScholarPubMed
13.Mohrs, O, Petersen, S, Voigtlaender, T, et al. Time-resolved contrast-enhanced MR angiography of the thorax in adults with congenital heart disease. Am J Roentgenol 2006; 187: 1107–1114.CrossRefGoogle ScholarPubMed