title: Delayed-enhancement cardiovascular magnetic resonance identifies fibrous tissue in children after surgery for congenital heart disease.
abstract: OBJECTIVE
  To determine whether delayed-enhancement magnetic resonance imaging can identify fibrous tissue associated with patch reconstructions in postoperative patients with congenital heart disease. Additionally, to determine whether fibrous structures not directly related to the surgical reconstruction exhibited delayed enhancement.
  
  
  METHODS
  Seventy-three patients underwent magnetic resonance imaging. Studies were retrospectively reviewed for the presence of delayed enhancement along the ventricular outflow tracts, cardiac valves, and where available, the ascending aorta. Three groups were identified. Group A patients (n = 34) underwent right ventricular outflow tract reconstruction and ventricular septal defect patch closure. Group B patients (n = 33) had never undergone cardiac surgery. Group C patients (n = 6) had functional single ventricle and underwent Norwood reconstruction.
  
  
  RESULTS
  In group A, 31 of 34 patients had delayed enhancement of the right ventricular outflow tract, and 14 of 34 had delayed enhancement of the ventricular septal defect patch (P < .001). In group B (n = 33), 1 patient with arrhythmogenic right ventricular dysplasia had delayed enhancement limited to the right ventricular outflow tract. The remainder had no delayed enhancement of either outflow tract. Delayed enhancement of the aortic valve and ascending aorta was observed in 13 of 34 (P = .002) and 10 of 26 (P = .05) group A patients, respectively, compared with 2 of 33 and 3 of 24 group B patients. In group C, delayed enhancement of the Norwood reconstruction was observed in 5 of 6 patients (P = .002).
  
  
  CONCLUSIONS
  Delayed-enhancement imaging detects fibrous tissue along regions of reconstruction in patients who have had surgery for congenital heart disease. Furthermore, delayed-enhancement imaging detects fibrous tissue in regions not directly related to the reconstructive surgery, including cardiac valves and the wall of the ascending aorta.
authors.affiliation: Department of Pediatrics, Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa 19103, USA. harrismat@email.chop.edu
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Harris
authors.forename: Tiffanie R
authors.initials: TR
authors.lastname: Johnson
authors.forename: Paul M
authors.initials: PM
authors.lastname: Weinberg
authors.forename: Mark A
authors.initials: MA
authors.lastname: Fogel
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005355:Fibrosis / Q000473:pathology; D019786:Gadolinium DTPA; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007089:Image Enhancement; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000473:pathology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012016:Reference Values; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D019786:Gadolinium DTPA