Pre-operative evaluation with magnetic resonance imaging in tetralogy of fallot and pulmonary atresia with ventricular septal defect.
BACKGROUND
Preoperative evaluation of patients with pulmonary atresia and ventricular septal defect (PA/ VSD) are generally done by echocardiogram and cardiac catheterization. The authors' objective of the present study was to compare the findings of Gadolinium (Gd) enhanced cardiac magnetic resonance angiography (MRA) with cardiac catheterization.


METHODS
Patients who had PA/VSD were prospectively evaluated using cardiac catheterization and cardiac MRA. A branch of the pulmonary arteries was divided into: main pulmonary artery (MPA), left and right branch pulmonary artery (LPA & RPA), major aortopulmonary collateral arteries (MAPCA) and minor collaterals. Each study was interpreted blindly. The agreement of findings was compared using Kappa statistics.


RESULTS
There were 43 patients who received both cardiac catheterization and cardiac MRI within a 2 month period The average age was 13.8 +/- 8.4 (2-30) years-old. There was an agreement among measurement of both MPA and LPA & RPA with Kappa statistics of more than 0.8. Gd-enhanced MRA was able to identify more branches of MAPCA when compared to cardiac catheterization.


CONCLUSIONS
The results of the present study indicate that Gd-enhanced MRA is a feasible, fast and accurate technique for identification of all sources of pulmonary blood supply in patients with complex pulmonary atresia. The present study was a noninvasive alternative to cardiac catheterization. Gd-enhanced MRA can better delineate small (minor) branches of collateral.
Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Prannok Road, Bangkok 10700, Thailand. sikdr@mahidol.ac.th
Kritvikrom
K
Durongpisitkul
Pairash
P
Saiviroonporn
Jarupim
J
Soongswang
Duangmanee
D
Laohaprasitiporn
Prakul
P
Chanthong
Apichart
A
Nana
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation; D005240:Feasibility Studies; D005260:Female; D005682:Gadolinium; D006345:Heart Septal Defects, Ventricular / Q000175:diagnosis*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000295:instrumentation / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D011300:Preoperative Care; D011446:Prospective Studies; D018633:Pulmonary Atresia / Q000175:diagnosis*; D013771:Tetralogy of Fallot / Q000175:diagnosis*
D005682:Gadolinium