Cardiac magnetic resonance imaging after stage I Norwood operation for hypoplastic left heart syndrome.
BACKGROUND
After the Norwood operation, a patient's suitability for proceeding to a bidirectional cavopulmonary connection (BCPC) is assessed by a combination of echocardiography and diagnostic cardiac catheterization. In this study, we describe the results of 37 patients who underwent cardiovascular magnetic resonance (MR) assessment before BCPC.


RESULTS
Cardiovascular MR and echocardiography were performed in 37 infants with hypoplastic left heart syndrome before BCPC, and the findings were compared with surgical findings. MR assessment of ventricular function and valvar regurgitation were compared with echocardiography. MR exhibited high sensitivity and specificity for identification of neoaortic (sensitivity 86%, specificity 97%) and left pulmonary artery (sensitivity 100%, specificity 94%) obstruction. Echocardiography exhibited poor sensitivity for identification of vascular stenosis. The mean right ventricular ejection fraction calculated from the MR data was 50+/-10%. There was general agreement between MR and echocardiographic measures of ventricular function, although patients with good function on echocardiography demonstrated a wide range of ejection fractions. There was good agreement between MR and echocardiography for identification of valvar regurgitation.


CONCLUSIONS
Cardiovascular MR can be used to define ventricular and valvar function and vascular anatomy in infants with hypoplastic left heart syndrome after the Norwood operation. We have shown how this information can be used to plan the BCPC and identify any revisions or additional valvar surgery.
Muthurangu
Vivek
V
Cardiac MR Research Group, Division of Imaging Sciences, King's College London, United Kingdom.
Taylor
Andrew M
AM
Hegde
Sanjeet R
SR
Johnson
Robert
R
Tulloh
Robert
R
Simpson
John M
JM
Qureshi
Shakeel
S
Rosenthal
Eric
E
Baker
Edward
E
Anderson
David
D
Razavi
Reza
R
D001011:Aorta / Q000502:physiology; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006348:Cardiac Surgical Procedures; D004452:Echocardiography; D005682:Gadolinium; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006351:Heart Valves / Q000502:physiology; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D012680:Sensitivity and Specificity; D013318:Stroke Volume
D005682:Gadolinium