title: 3-dimensional time-resolved contrast-enhanced magnetic resonance angiography for evaluation late after the mustard operation for transposition.
abstract: OBJECTIVE
  Cardiovascular magnetic resonance assessment of adults late after an atrial redirection operation for transposition is demanding and time consuming. We hypothesised that the relatively fast and standardised 3-dimensional time-resolved contrast-enhanced magnetic resonance angiography, or dynamic angiography, would be valuable in the periodic follow-up of these patients.
  
  
  METHODS
  We investigated prospectively 36 adults with transposition using dynamic angiography, comparing our results against a comprehensive but non-contrast cardiovascular magnetic resonance protocol. We acquired 6 dynamic angiographic datasets after injection of contrast. The primary aim was to detect significant obstruction of the pathways for venous flow.
  
  
  RESULTS
  In 4 patients (11%), we found evidence of moderate-to-severe, and thus clinically important, obstruction of systemic venous channels on standard cardiovascular magnetic resonance. All these patients were correctly identified by dynamic angiography. In 4 additional patients, we found mild and haemodynamically insignificant obstructions in the systemic venous channels. Of the 8 (22%) patients with any obstruction, 6 were detected by angiography. There were no false positives reported, giving sensitivity of 75% and specificity of 100%, a positive predictive value of 100%, and negative predictive value of 93%. In 1 patient, there was a moderate obstruction of the pulmonary venous compartment which was not readily seen by dynamic angiography.
  
  
  CONCLUSIONS
  3-dimensional dynamic angiography is a useful method for detecting anatomically moderate-to-severe, but not mild, obstructions in the systemic venous channels following Mustard repair for transposition. This technique can be used as a single imaging method and/or as complimentary to standard two dimensional cardiovascular magnetic resonance techniques for detection of clinically important obstructions in the systemic venous channels.
authors.affiliation: Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK.
authors.forename: Bengt
authors.initials: B
authors.lastname: Johansson
authors.forename: Sonya V
authors.initials: SV
authors.lastname: Babu-Narayan
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Kilner
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Cannell
authors.forename: Raad H
authors.initials: RH
authors.lastname: Mohiaddin
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000175:diagnosis; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D011667:Pulmonary Veins; D012680:Sensitivity and Specificity; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000601:surgery*; D014683:Vena Cava, Superior; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult
chemical_list: D003287:Contrast Media