Cardiac Magnetic Resonance
Cardiovascular magnetic resonance (CMR) has expanded its role in the diagnosis and management of congenital heart disease (CHD). The combination of physiological data with 2D and 3D anatomy enables CMR to provide a unique perspective for the pre- and postoperative management of patients with CHD.
KeywordsCardiovascular magnetic resonance Congenital heart disease Cardiac imaging Angiography 3D anatomy
Superior vena cava interruption—time-resolved contrast-enhanced MR angiography. Seventeen-year-old boy with transposition of the great arteries and pulmonary artery stenosis. He underwent arterial switch operation as a newborn and a cardiac catheterization to implant a stent in the right pulmonary artery at 9 years of age. Time-resolved contrast-enhanced MR angiography showed complete occlusion of the superior vena cava. Time-resolved contrast-enhanced MR angiography is a real-time dynamic contrast MR angiography to specifically assess contrast flow dynamics in arteries and veins. Rapid sequential images are acquired during the contrast bolus to obtain vascular anatomy and functional information. The contrast injected in a peripheral vein in the right upper arm does not enter the superior vena cava which is closed, but it takes an alternative path into the azygos vein. The azygos vein usually drains toward the superior vena cava. In this case it drains in a craniocaudal direction into the inferior vena cava and the right atrium. From the right atrium, contrast highlights right ventricle and pulmonary arteries. Pulmonary parenchymal perfusion can be evaluated. Contrast returns to the heart through the pulmonary veins, enters the left atrium and left ventricle, and highlights the aorta (AVI 637 kb)
Percutaneous pulmonary valve dislocation. Tetralogy of Fallot patient who underwent correction with transannular patch in infancy, stents in both pulmonary arteries to treat stenosis, and percutaneous pulmonary valve implantation (PPVI) for severe pulmonary regurgitation. Six months after PPVI, he has been evaluated with cardiac MR. On MR the stent of the percutaneous valve appears black. 2D SSFP cine images showed dislocation of the percutaneous pulmonary valve which was floating in the right ventricular outflow tract (MP4 2216 kb)