Mid-term follow-up of patients with transposition of the great arteries after atrial inversion operation using two- and three-dimensional magnetic resonance imaging.
BACKGROUND
Older patients with transposition of the great arteries who have undergone an atrial inversion procedure (ATRIAL-INV) are difficult to image by echocardiography. The surgical baffles are spatially complex.


OBJECTIVE
To test the hypothesis that two- and three-dimensional MRI can elucidate the spatially complex anatomy in this patient population.


METHODS
Twelve patients with ATRIAL-INV, ages 16+/-4.5 years, underwent routine T1-weighted spin-echo axial imaging to obtain a full cardiac volumetric data set. Postprocessing created three-dimensional shaded surface displays and allowed for multiplanar reconstruction. Routine transthoracic echocardiography was available on all patients.


RESULTS
Three-dimensional reconstruction enabled complete spatial conceptualization of the venous pathways, and allowed for precise localization of a narrowed region in the upper limb of the systemic venous pathway found in two patients. This was subsequently confirmed on angiography. Routine MRI was able to image the full extent of the venous pathways in all 12 patients. Routine transthoracic echocardiography was able to visualize proximal portions of the venous pathways in eight (67%), the distal upper limb in five (42%), and the distal lower limb in four (33%) patients, and it was able to visualize the outflow tracts in all patients.


CONCLUSIONS
Three-dimensional reconstruction adds important spatial information, which can be especially important in stenotic regions. Routine MRI is superior to transthoracic echocardiography in delineation of the systemic and pulmonary venous pathway anatomy of ATRIAL-INV patients at mid-term follow-up. Although transesophageal echocardiography is an option, it is more invasive.
Fogel
Mark A
MA
Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA 19104, USA. fogel@email.chop.edu
Hubbard
Anne
A
Weinberg
Paul M
PM
D000293:Adolescent; D000328:Adult; D002648:Child; D004452:Echocardiography; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*