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Magnetic Resonance Assessment of RV Remodeling and Function

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Right Ventricular Physiology, Adaptation and Failure in Congenital and Acquired Heart Disease

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Abstract

Cardiac magnetic resonance imaging (CMR) provides unique opportunities for the assessment of right ventricular (RV) geometry, function, and myocardial structure. These allow CMR to play a pivotal role in diagnosis, monitoring, and decision-making in pediatric and congenital cardiology. CMR is the reference standard for quantification of RV volume, ejection fraction and mass. Phase contrast flow velocity mapping by CMR offers an accurate measurement of pulmonary blood flow and of the degree of pulmonary regurgitation in the presence of pulmonary valvar insufficiency, for example after Tetralogy of Fallot repair. More recently, CMR has been employed for the quantification of RV strain, rotation, and torsion. CMR allows for the complete visualization of the RV as compared to echocardiography, but is hampered by inferior temporal resolution, particular for the assessment of diastolic function. Scar imaging with late gadolinium enhancement CMR is established as a risk predictor in certain types of congenital and acquired heart disease, although it can be difficult to detect scarring with certainty in the thin walled RV myocardium. For the same reason, the assessment of diffuse myocardial fibrosis in the RV by CMR T1 mapping is challenging.

In this chapter we describe the technical underpinnings of CMR for the RV, outline its utility and limitations in pediatric and congenital heart disease, and provide examples on how CMR contributes to clinical decision making.

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Authors and Affiliations

  1. Paediatric Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, 555 University Ave, Toronto, ON M1G 1X8, Canada

    Lars Grosse-Wortmann

  2. University of Michigan, Congenital Heart Center, Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, 1540 E. Hospital Drive, Ann Arbor, MI, 48109, USA

    Adam L. Dorfman

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Correspondence to Lars Grosse-Wortmann .

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Editors and Affiliations

  1. Paediatric Cardiology, Labatt Family Heart Center Hospital for Sick Children, Toronto, Ontario, Canada

    Mark K. Friedberg

  2. Heart Institute, Cincinnati Children’s Hosp Med Center, Cincinnati, Ohio, USA

    Andrew N. Redington

Electronic Supplementary Material

Short axis of steady state free precession images at end-diastole in a patient with Tetralogy of Fallot (AVI 1221 kb)

Axial stack of steady state free precession images at end-diastole in a patient with Tetralogy of Fallot (AVI 1256 kb)

Four-dimensional phase contrast imaging in a patient with Tetralogy of Fallot, depicting the streamlines of flow during systole (a) and diastole (b). Note the flow acceleration in the right ventricular outflow tract during systole and flow reversal during diastole (images and movie courtesy of M. Rose, M. Markl, J. Robinson, C. Rigsby, Northwestern University, Chicago, IL) (MPG 2504 kb)

Tagged short axis CMR image. The grid superimposed on the heart deforms with the myocardium through the cardiac cycle. Note that the spacing between the tag lines is wider than the free wall of the right ventricle, limiting the use of CMR tagging for analysis of right ventricular mechanics (AVI 48600 kb)

Cardiac magnetic resonance feature tracking analysis in a patient with repaired tetralogy of Fallot (AVI 18145 kb)

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Grosse-Wortmann, L., Dorfman, A.L. (2018). Magnetic Resonance Assessment of RV Remodeling and Function. In: Friedberg, M., Redington, A. (eds) Right Ventricular Physiology, Adaptation and Failure in Congenital and Acquired Heart Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-67096-6_10

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