Time-resolved three-dimensional contrast-enhanced magnetic resonance angiography in patients who have undergone a Fontan operation or bidirectional cavopulmonary connection: initial experience.
OBJECTIVE
To evaluate the usefulness of time-resolved three-dimensional (3D) magnetic resonance angiography (MRA) using diluted contrast agent (CA) in patients who had undergone a Fontan operation or bidirectional cavopulmonary connection (BCPC).


METHODS
Time-resolved 3D MRA (10 dynamic data sets, two seconds per dynamic data set) using parallel imaging and keyhole data sampling was performed on 15 patients (median age=10 years, range=1-20 years) who had undergone a Fontan operation (N=11) or BCPC (N=4). Diluted gadolinium (Gd) contrast agent (CA) was intravenously injected into the arm and/or leg veins. The flow dynamics and morphology of pulmonary circulation, and lung perfusion were assessed.


RESULTS
Preferential or balanced pulmonary blood flow from each systemic vein was visualized on time-resolved 3D MRA in all patients. In addition, occlusion/stenosis of the central thoracic vein (N=4) and pulmonary artery (N=6), systemic venous (N=5) and arterial (N=6) collaterals, and lung perfusion defect (N=4) were identified. Persistent hepatic venous plexus, pulmonary arteriovenous malformation, and axillary arteriovenous fistula were delineated in three patients, respectively.


CONCLUSIONS
Time-resolved 3D MRA with diluted CA is useful for evaluating patients who have undergone a Fontan operation or BCPC because it can reveal the flow dynamics and morphology of pulmonary circulation, and lung perfusion status.
Goo
Hyun Woo
HW
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. hwgoo@amc.seoul.kr
Yang
Dong Hyun
DH
Park
In-Sook
IS
Ko
Jae Kon
JK
Kim
Young Hwee
YH
Seo
Dong-Man
DM
Yun
Tae-Jin
TJ
Park
Jeong-Jun
JJ
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000175:diagnosis; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D018729:Fontan Procedure; D005682:Gadolinium / Q000008:administration & dosage; D018610:Heart Bypass, Right; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D011652:Pulmonary Circulation / Q000502:physiology*; D011856:Radiographic Image Enhancement; D013909:Thorax / Q000098:blood supply
D003287:Contrast Media; D005682:Gadolinium