3-dimensional time-resolved contrast-enhanced magnetic resonance angiography for evaluation late after the mustard operation for transposition.
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.
Johansson
Bengt
B
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK.
Babu-Narayan
Sonya V
SV
Kilner
Philip J
PJ
Cannell
Timothy M
TM
Mohiaddin
Raad H
RH
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
D003287:Contrast Media