Preoperative evaluation of pulmonary artery morphology and pulmonary circulation in neonates with pulmonary atresia--usefulness of MR angiography in clinical routine.
BACKGROUND
To explore the role of contrast-enhanced magnetic resonance angiography (CE-MRA) in clinical routine for evaluating neonates with pulmonary atresia (PA) and to describe their pulmonary artery morphology and blood supply.CE-MRA studies of 15 neonates with PA (12 female; median weight: 2900 g) were retrospectively evaluated by two radiologists in consensus. Each study was judged to be either diagnostic or non-diagnostic depending on the potential to evaluate pulmonary artery morphology and pulmonary blood supply. In those cases where surgery or conventional angiocardiography was performed results were compared.


RESULTS
CE-MRA was considered diagnostic in 87%. Pulmonary artery morphology was classified as "confluent with (n = 1) and without (n = 1) main pulmonary artery", "non-confluent" (n = 6) or "absent" (n = 7). Source of pulmonary blood supply was "a persistent arterial duct" (n = 12), "a direct" (n = 22) or "indirect (n = 9) aortopulmonary collateral artery (APCA)" or "an APCA from the ascending aorta" (n = 2). In no patient were there any additional findings at surgery or conventional angiocardiography which would have changed the therapeutic or surgical approach.


CONCLUSIONS
CE-MRA is a useful diagnostic tool for the preoperative evaluation of the morphology of pulmonary arteries and blood supply in neonates with PA. In most cases diagnostic cardiac catheterization can be avoided.
Kawel
Nadine
N
Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland. nadine.kawel@gmx.de
Valsangiacomo-Buechel
Emanuela
E
Hoop
Ricarda
R
Kellenberger
Christian J
CJ
D000790:Angiocardiography; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007231:Infant, Newborn; D018810:Magnetic Resonance Angiography; D008297:Male; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011651:Pulmonary Artery / Q000002:abnormalities / Q000473:pathology* / Q000503:physiopathology; D018633:Pulmonary Atresia / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D013557:Switzerland
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA