title: Cardiovascular magnetic resonance catheterization derived pulmonary vascular resistance and medium-term outcomes in congenital heart disease.
abstract: BACKGROUND
  Selection of patients with congenital heart disease for surgical septation in biventricular repair or surgical palliation in functionally single ventricles requires low pulmonary vascular resistance (PVR). Where there is uncertainty, PVR can be assessed using hybrid cardiovascular magnetic resonance (CMR) and fluoroscopic (X-Ray) guided cardiac catheterizations (XMR). CMR/XMR catheterization is a validated technique for accurate assessment of pulmonary vascular resistance. However, data concerning its application in clinical practice is lacking.
  
  
  METHODS
  PVR assessments were performed in 167 studies in 149 congenital heart disease patients by CMR/XMR catheterization. Data was collated on patient demographics, procedural data, complications and outcomes. Institutional ethics approval was obtained.
  
  
  RESULTS
  Median age was 3.6 years (6 days-67 years) and weight 13.8 kg (2.3-122 kg). One hundred and eight studies were in biventricular circulations and 59 in functionally single ventricles. Median radiation dose was 0.72 mSv. A baseline Qp:Qs ≤2.75 in biventricular circulations with left-to-right shunts predicted a PVR ≥6 WU x m(2) with 100% sensitivity and 48% specificity. Median follow up until death or last review was 4.2 years (4 days-11 years). Eighty-four patients had a surgical or catheter intervention based on CMR/XMR catheterization findings at a median of 94 days after the study. This included successful biventricular repair at resting PVR values ≤6 WU x m(2) and Fontan completion at  ≤4 WU x m(2).
  
  
  CONCLUSIONS
  PVR measured by CMR/XMR catheterization allows accurate stratification for intervention in patients with congenital heart disease in both, biventricular and univentricular circulations.
authors.affiliation: Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK. kuberan.pushparajah@gstt.nhs.uk.|Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. kuberan.pushparajah@gstt.nhs.uk.
authors.forename: Kuberan
authors.initials: K
authors.lastname: Pushparajah
authors.affiliation: Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK. aphrodite.tzifa@kcl.ac.uk.
authors.forename: Aphrodite
authors.initials: A
authors.lastname: Tzifa
authors.affiliation: Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. aaron.bell@gstt.nhs.uk.
authors.forename: Aaron
authors.initials: A
authors.lastname: Bell
authors.affiliation: Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK. james.k.wong@kcl.ac.uk.
authors.forename: James K
authors.initials: JK
authors.lastname: Wong
authors.affiliation: Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK. mohammad.hussain@kcl.ac.uk.|Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. mohammad.hussain@kcl.ac.uk.
authors.forename: Tarique
authors.initials: T
authors.lastname: Hussain
authors.affiliation: Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK. israel.valverde@kcl.ac.uk.
authors.forename: Israel
authors.initials: I
authors.lastname: Valverde
authors.affiliation: Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. hannah.bellsham-revell@kcl.ac.uk.
authors.forename: Hannah R
authors.initials: HR
authors.lastname: Bellsham-Revell
authors.affiliation: Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK. gerald.greil@kcl.ac.uk.|Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. gerald.greil@kcl.ac.uk.
authors.forename: Gerald
authors.initials: G
authors.lastname: Greil
authors.affiliation: Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK. john.simpson@gstt.nhs.uk.|Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. john.simpson@gstt.nhs.uk.
authors.forename: John M
authors.initials: JM
authors.lastname: Simpson
authors.affiliation: Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK. tobias.schaeffter@kcl.ac.uk.
authors.forename: Tobias
authors.initials: T
authors.lastname: Schaeffter
authors.affiliation: Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK. reza.razavi@kcl.ac.uk.|Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. reza.razavi@kcl.ac.uk.
authors.forename: Reza
authors.initials: R
authors.lastname: Razavi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002407:Catheterization, Swan-Ganz / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D011651:Pulmonary Artery / Q000503:physiopathology*; D011652:Pulmonary Circulation; D012372:ROC Curve; D015641:Radiography, Interventional; D012307:Risk Factors; D014655:Vascular Resistance; D055815:Young Adult