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Cardiac magnetic resonance predictors for successful primary biventricular repair of unbalanced complete common atrioventricular canal

Published online by Cambridge University Press:  18 July 2023

Andrea L. Jones*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Brian R. White
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Reena M. Ghosh
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Antara Mondal
Affiliation:
Department of Biomedical & Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Steve Ampah
Affiliation:
Department of Biomedical & Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Deborah Y. Ho
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
Kevin Whitehead
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Matthew A. Harris
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
David M. Biko
Affiliation:
Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Sara Partington
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Stephanie Fuller
Affiliation:
Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
Meryl S. Cohen
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Mark A. Fogel
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
*
Corresponding author: A. L. Jones; Email: Jonesa21@chop.edu

Abstract

Background:

Patients with unbalanced common atrioventricular canal can be difficult to manage. Surgical planning often depends on pre-operative echocardiographic measurements. We aimed to determine the added utility of cardiac MRI in predicting successful biventricular repair in common atrioventricular canal.

Methods:

We conducted a retrospective cohort study of children with common atrioventricular canal who underwent MRI prior to repair. Associations between MRI and echocardiographic measures and surgical outcome were tested using logistic regression, and models were compared using area under the receiver operator characteristic curve.

Results:

We included 28 patients (median age at MRI: 5.2 months). The optimal MRI model included the novel end-diastolic volume index (using the ratio of left ventricular end-diastolic volume to total end-diastolic volume) and the left ventricle–right ventricle angle in diastole (area under the curve 0.83, p = 0.041). End-diastolic volume index ≤ 0.18 and left ventricle–right ventricle angle in diastole ≤ 72° yield a sensitivity of 83% and specificity of 81% for successful biventricular repair. The optimal multimodality model included the end-diastolic volume index and the echocardiographic atrioventricular valve index with an area under the curve of 0.87 (p = 0.026).

Conclusions:

Cardiac MRI can successfully predict successful biventricular repair in patients with unbalanced common atrioventricular canal utilising the end-diastolic volume index alone or in combination with the MRI left ventricle–right ventricle angle in diastole or the echocardiographic atrioventricular valve index. A prospective cardiac MRI study is warranted to better define the multimodality characteristic predictive of successful biventricular surgery.

Type
Original Article
Copyright
© The Author(s), 2023. Published by Cambridge University Press

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