title: The comparative role of echocardiography and MRI for identifying critical lesions in patients with single-ventricle physiology, before bidirectional cavopulmonary connection.
abstract: BACKGROUND
  In the era of multi-modality imaging, this study compared contemporary, pre-operative echocardiography and cardiac MRI in predicting the need for intervention on additional lesions before surgical bidirectional cavopulmonary connection.
  
  
  METHODS
  A total of 72 patients undergoing bidirectional cavopulmonary connection for single-ventricle palliation between 2007 and 2012, who underwent pre-operative assessment using both echocardiography and MRI, were included. The pre-determined outcome measure was any additional surgical or catheter-based intervention within 6 months of bidirectional cavopulmonary connection. Indices assessed were as follows: indexed dimensions of right and left pulmonary arteries, coarctation of the aorta, adequacy of interatrial communication, and degree of atrioventricular valve regurgitation.
  
  
  RESULTS
  Median age at bidirectional cavopulmonary connection was 160 days (interquartile range 121-284). The following MRI parameters predicted intervention: Z score for right pulmonary artery (odds ratio 1.77 (95% confidence interval 1.12-2.79, p=0.014)) and left pulmonary artery dimensions (odds ratio 1.45 (1.04-2.00, p=0.027)) and left pulmonary artery report conclusion (odds ratio 1.57 (1.06-2.33)). The magnetic resonance report predicted aortic arch intervention (odds ratio 11.5 (3.5-37.7, p=0.00006)). The need for atrioventricular valve repair was associated only with magnetic resonance regurgitation fraction score (odds ratio 22.4 (1.7-295.1, p=0.018)). Echocardiography assessment was superior to MRI for predicting intervention on interatrial septum (odds ratio 27.7 (6.3-121.6, p=0.00001)).
  
  
  CONCLUSIONS
  For branch pulmonary arteries, aortic arch, and atrioventricular valve regurgitation, MRI parameters more reliably predict the need for intervention; however, echocardiography more accurately identified the adequacy of interatrial communication. Approaching bidirectional cavopulmonary connection, the diagnostic strengths of MRI and echocardiography should be acknowledged when considering intervention.
authors: 1Cardiorespiratory Unit,UCL Institute of Cardiovascular Science,Great Ormond Street Hospital for Children,London,United Kingdom.
authors: Sylvia
authors: S
authors: Krupickova
authors: 2Centre for Cardiovascular Imaging,UCL Institute of Cardiovascular Science,Great Ormond Street Hospital for Children,London,United Kingdom.
authors: Michael A
authors: MA
authors: Quail
authors: 1Cardiorespiratory Unit,UCL Institute of Cardiovascular Science,Great Ormond Street Hospital for Children,London,United Kingdom.
authors: Robert
authors: R
authors: Yates
authors: 3Children's Heart Centre,University Hospital Motol,Prague,Czech Republic.
authors: Roman
authors: R
authors: Gebauer
authors: 1Cardiorespiratory Unit,UCL Institute of Cardiovascular Science,Great Ormond Street Hospital for Children,London,United Kingdom.
authors: Marina
authors: M
authors: Hughes
authors: 1Cardiorespiratory Unit,UCL Institute of Cardiovascular Science,Great Ormond Street Hospital for Children,London,United Kingdom.
authors: Jan
authors: J
authors: Marek
mesh_terms: D001011:Aorta / Q000000981:diagnostic imaging*; D018153:Czech Republic; D004452:Echocardiography; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D012189:Retrospective Studies
keywords: Bidirectional cavopulmonary connection; cardiac magnetic resonance; echocardiography