Composite graft replacement of the ascending aorta: leakage detection with gadolinium-enhanced MR imaging.
OBJECTIVE
To assess the value of magnetic resonance (MR) imaging in the detection of postoperative complications after composite valve graft replacement.


METHODS
Spin-echo and gradient-echo MR imaging was performed in 52 patients 1/2 to 200 months after composite graft replacement of the ascending aorta (22 for dissection, 30 for aneurysm). The prosthetic aortic segment, distal and proximal anastomoses, general morphologic characteristics, and diameter of the reimplanted coronary arteries were evaluated. In patients with abnormal perigraft thickening, additional spin-echo imaging was performed after injection of gadopentetate dimeglumine.


RESULTS
Normal postoperative perigraft thickening (< or = 10 mm) was observed in 42 patients. Ten patients had abnormal periprosthetic thickening of 15-52 mm. Gadolinium-enhanced MR imaging demonstrated leakage in five of those 10 patients. The lack of enhancement excluded the presence of bleeding in the remaining five patients (three with chronic hematomas, one with infection, and one with granulation tissue). These findings were confirmed at surgery or with subsequent follow-up MR examinations.


CONCLUSIONS
MR imaging was an optimal imaging modality for evaluating the morphologic characteristics of composite grafts and reimplanted coronary arteries. Gadolinium-enhanced MR imaging is a simple, accurate, and noninvasive method for detecting a leak, which necessitates urgent repeat surgery.
Fattori
R
R
Institute of Radiology and Cardiovascular Surgery, Ospedale S Orsola, Bologna, Italy. ross@med.unibo.it
Descovich
B
B
Bertaccini
P
P
Celletti
F
F
Caldarera
I
I
Pierangeli
A
A
Gavelli
G
G
D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*
D003287:Contrast Media; D019786:Gadolinium DTPA