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MRT zur Therapiekontrolle bei Patienten mit Fallot-Tetralogie

MRI for therapy control in patients with tetralogy of Fallot

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Zusammenfassung

Die Fallot-Tetralogie (TOF) ist mit einer Prävalenz zwischen 0,26 und 0,8‰ aller Lebendgeburten der häufigste Herzfehler mit primärer Zyanose. Durch verbesserte Operationstechniken erreichen heute nahezu alle Patienten das Erwachsenenalter. Bei fast allen Patienten tritt eine postoperative Pulmonalinsuffizienz (PI) auf, die entscheidenden Einfluss auf die langfristige Morbidität und Mortalität hat. Die kardiale Magnetresonanztomographie (MRT) ist für Quantifizierung von Ventrikelfunktion und Klappeninsuffizienzen etabliert und aufgrund ihrer fehlenden Invasivität und Strahlenexposition sehr gut für regelmäßige Verlaufskontrollen der heranwachsenden Patienten geeignet. Insbesondere der Zeitpunkt für einen Pulmonalklappenersatz darf nicht verpasst werden, da sich die rechtsventrikulären (RV) Volumina nur normalisieren, wenn das präoperative enddiastolische Volumen unter 170 ml/m2 und das endsystolische Volumen unter 85 ml/m2 liegen. Stenosen der Pulmonalarterien betreffen bis zu 15% der Patienten nach der Korrekturoperation. Distale Stenosen können eine vorbestehende PI verstärken und über eine kombinierte Druck- und Volumenbelastung zu einer Rechtsherzinsuffizienz führen. Sie müssen daher frühzeitig erkannt und mit einer Ballondilatation und eventuell einer Stenteinlage behandelt werden.

Abstract

With prevalences ranging from 0.26 to 0.8‰ of all live births tetralogy of Fallot (TOF) is the most common congenital heart disease with primary cyanosis. Due to improvements in surgical techniques, nearly all patients can nowadays expect to reach adulthood. After surgical repair, pulmonary regurgitation (PR) occurs in almost every child and is an important contributing factor in long-term morbidity and mortality. Cardiac magnetic resonance imaging is well established for functional assessment and flow measurements and is an ideal tool for serial post-surgical follow-up examinations, as it is non-invasive and does not expose patients to ionizing radiation. The timing of pulmonary valve replacement is crucial as right ventricular (RV) volumes have only proven to normalize when preoperative end-diastolic volumes are <170 ml/m2 and end-systolic volumes are <85 ml/m2. After surgical repair up to 15% of patients have residual or recurrent pulmonary artery stenosis. Distal pulmonary branch stenosis can aggravate PR and lead to right heart failure due to combined pressure and volume overload. Therefore, it has to be diagnosed in time and treated by angioplasty with or without stenting.

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Literatur

  1. Christian A, Gary DW, Andrew NR (2009) Tetralogy of Fallot. Lancet 374:1462–1471

    Article  CAS  Google Scholar 

  2. Helbing WA, de Roos A (2000) Clinical applications of cardiac magnetic resonance imaging after repair of tetralogy of Fallot. Pediatr Cardiol 21:70–79

    Article  CAS  PubMed  Google Scholar 

  3. Sandner TA, Theisen D, Bauner KU et al (2010) Cardiac functional analysis with MRI. Radiologe 50:514–522

    Article  CAS  PubMed  Google Scholar 

  4. Lotz J (2007) Flow measurements in cardiac MRI. Radiologe 47:333–341

    Article  CAS  PubMed  Google Scholar 

  5. Sagmeister F, Herrmann S, Ritter C et al (2010) Functional cardiac MRI for assessment of aortic valve disease. Radiologe 50:541–547

    Article  CAS  PubMed  Google Scholar 

  6. Nael K, Krishnam M, Ruehm SG et al (2009) Time-resolved MR angiography in the evaluation of central thoracic venous occlusive disease. AJR Am J Roentgenol 192:1731–1738

    Article  PubMed  Google Scholar 

  7. Gatzoulis MA, Clark AL, Cullen S et al (1995) Right ventricular diastolic function 15 to 35 years after repair of tetralogy of Fallot. Restrictive physiology predicts superior exercise performance. Circulation 91:1775–1781

    CAS  PubMed  Google Scholar 

  8. Helbing WA, Bosch HG, Maliepaard C et al (1995) Comparison of echocardiographic methods with magnetic resonance imaging for assessment of right ventricular function in children. Am J Cardiol 76:589–594

    Article  CAS  PubMed  Google Scholar 

  9. Geva T, Sandweiss BM, Gauvreau K et al (2004) Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol 43:1068–1074

    Article  PubMed  Google Scholar 

  10. Grothues F, Moon JC, Bellenger NG et al (2004) Interstudy reproducibility of right ventricular volumes, function, and mass with cardiovascular magnetic resonance. Am Heart J 147:218–223

    Article  PubMed  Google Scholar 

  11. Hui W, Abd El Rahman MY, Dsebissowa F et al (2005) Comparison of modified short axis view and apical four chamber view in evaluating right ventricular function after repair of tetralogy of Fallot. Int J Cardiol 105:256–261

    Article  CAS  PubMed  Google Scholar 

  12. Johnson TR, Hoch M, Huber A et al (2006) Quantification of right ventricular function in congenital heart disease: correlation of 3D echocardiography and MRI as complementary methods. Rofo 178:1014–1021

    CAS  PubMed  Google Scholar 

  13. Ghai A, Silversides C, Harris L et al (2002) Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of Fallot. J Am Coll Cardiol 40:1675–1680

    Article  PubMed  Google Scholar 

  14. Abd El Rahman MY, Abdul-Khaliq H, Vogel M et al (2000) Relation between right ventricular enlargement, QRS duration, and right ventricular function in patients with tetralogy of Fallot and pulmonary regurgitation after surgical repair. Heart 84:416–420

    Article  Google Scholar 

  15. Bellenger NG, Burgess MI, Ray SG et al (2000) Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable? Eur Heart J 21:1387–1396

    Article  CAS  PubMed  Google Scholar 

  16. Gutberlet M, Abdul-Khaliq H, Grothoff M et al (2003) Evaluation of left ventricular volumes in patients with congenital heart disease and abnormal left ventricular geometry. Comparison of MRI and transthoracic 3-dimensional echocardiography. Rofo 175:942–951

    CAS  PubMed  Google Scholar 

  17. Williams RG, Pearson GD, Barst RJ et al (2006) Report of the National Heart, Lung, and Blood Institute Working Group on research in adult congenital heart disease. J Am Coll Cardiol 47:701–707

    Article  PubMed  Google Scholar 

  18. Henkens IR, van Straten A, Schalij MJ et al (2007) Predicting outcome of pulmonary valve replacement in adult tetralogy of Fallot patients. Ann Thorac Surg 83:907–911

    Article  PubMed  Google Scholar 

  19. Therrien J, Provost Y, Merchant N et al (2005) Optimal timing for pulmonary valve replacement in adults after tetralogy of Fallot repair. Am J Cardiol 95:779–782

    Article  PubMed  Google Scholar 

  20. Vliegen HW, van Straten A, de Roos A et al (2002) Magnetic resonance imaging to assess the hemodynamic effects of pulmonary valve replacement in adults late after repair of tetralogy of Fallot. Circulation 106:1703–1707

    Article  PubMed  Google Scholar 

  21. Davlouros PA, Kilner PJ, Hornung TS et al (2002) Right ventricular function in adults with repaired tetralogy of Fallot assessed with cardiovascular magnetic resonance imaging: detrimental role of right ventricular outflow aneurysms or akinesia and adverse right-to-left ventricular interaction. J Am Coll Cardiol 40:2044–2052

    Article  PubMed  Google Scholar 

  22. Oosterhof T, Mulder BJ, Vliegen HW, de Roos A (2005) Corrected tetralogy of Fallot: delayed enhancement in right ventricular outflow tract. Radiology 237:868–871

    Article  PubMed  Google Scholar 

  23. Gatzoulis MA, Balaji S, Webber SA et al (2000) Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet 356:975–981

    Article  CAS  PubMed  Google Scholar 

  24. Westenberg JJ, Roes SD, Ajmone Marsan N et al (2008) Mitral valve and tricuspid valve blood flow: accurate quantification with 3D velocity-encoded MR imaging with retrospective valve tracking. Radiology 249:792–800

    Article  PubMed  Google Scholar 

  25. Chaturvedi RR, Redington AN (2007) Pulmonary regurgitation in congenital heart disease. Heart 93:880–889

    Article  PubMed  Google Scholar 

  26. Simpson IA, Maciel BC, Moises V et al (1993) Cine magnetic resonance imaging and color Doppler flow mapping displays of flow velocity, spatial acceleration, and jet formation: a comparative in vitro study. Am Heart J 126:1165–1174

    Article  CAS  PubMed  Google Scholar 

  27. Perron J, Moran AM, Gauvreau K et al (1999) Valved homograft conduit repair of the right heart in early infancy. Ann Thorac Surg 68:542–548

    Article  CAS  PubMed  Google Scholar 

  28. Yuan S-M, Mishaly D, Shinfeld A, Raanani E (2008) Right ventricular outflow tract reconstruction: valved conduit of choice and clinical outcomes. J Cardiovasc Med 9:327–337

    Article  Google Scholar 

  29. Karlo C, Leschka S, Goetti R et al (2010) High-pitch dual-source CT angiography of the aortic valve-aortic root complex without ECG-synchronization. Eur Radiol. [Epub ahead of print]

  30. Arnoldi E, Ramos-Duran L, Abro JA et al (2010) CT-Angiographie der Koronarien mit prospektivem EKG-Triggering. Radiologe 50:500–506

    Article  CAS  PubMed  Google Scholar 

  31. Fratz S, Schuhbaeck A, Buchner C et al (2009) Comparison of accuracy of axial slices versus short-axis slices for measuring ventricular volumes by cardiac magnetic resonance in patients with corrected tetralogy of Fallot. Am J Cardiol 103:1764–1769

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    D. Theisen & M.F. Reiser

  2. Abteilung für Kinderkardiologie und pädiatrische Intensivmedizin, Kinderherzzentrum, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, München, Deutschland

    R.D. Dalla Pozza

  3. Herzchirurgische Klinik, Kinderherzzentrum, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, München, Deutschland

    E. Malec

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  1. D. Theisen
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  2. R.D. Dalla Pozza
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  3. E. Malec
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  4. M.F. Reiser
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Correspondence to D. Theisen.

Zusatzmaterial online

117_2010_1995_MO1_ESM.mov

Video 1: Moderate PI nach transannulärer Patchplastik. Cine SSFP Darstellung der RVL und des RVOT (QuickTime Video 0,7 MB)

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Theisen, D., Dalla Pozza, R., Malec, E. et al. MRT zur Therapiekontrolle bei Patienten mit Fallot-Tetralogie. Radiologe 51, 44–51 (2011). https://doi.org/10.1007/s00117-010-1995-8

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  • DOI: https://doi.org/10.1007/s00117-010-1995-8

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