Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-23T18:40:11.581Z Has data issue: false hasContentIssue false
  • English
  • Français

The comparative role of echocardiography and MRI for identifying critical lesions in patients with single-ventricle physiology, before bidirectional cavopulmonary connection

Published online by Cambridge University Press:  04 February 2016

Sylvia Krupickova ,
Michael A. Quail ,
Robert Yates ,
Roman Gebauer ,
Marina Hughes  and
Jan Marek
Sylvia Krupickova
Affiliation:
Cardiorespiratory Unit, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, London, United Kingdom
Michael A. Quail
Affiliation:
Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, London, United Kingdom
Robert Yates
Affiliation:
Cardiorespiratory Unit, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, London, United Kingdom
Roman Gebauer
Affiliation:
Children’s Heart Centre, University Hospital Motol, Prague, Czech Republic
Marina Hughes
Affiliation:
Cardiorespiratory Unit, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, London, United Kingdom Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, London, United Kingdom
Jan Marek*
Affiliation:
Cardiorespiratory Unit, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, London, United Kingdom Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, London, United Kingdom
*
Correspondence to: Professor J. Marek, Consultant Paediatric Cardiologist, Lead of Echocardiography Department, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, United Kingdom. Tel: +44 20 7762 5000; Fax: +44 20 7829 8673; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

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)).

Conclusion

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.

Keywords

Bidirectional cavopulmonary connectionechocardiographycardiac magnetic resonance
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 7 , October 2016 , pp. 1373 - 1382
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Authors contributed equally.

References

1. Stern, KW, McElhinney, DB, Gauvreau, K, Geva, T, Brown, DW. Echocardiographic evaluation before bidirectional Glenn operation in functional single-ventricle heart disease: comparison to catheter angiography. Circ Cardiovasc Imaging 2011; 4: 498–505.CrossRefGoogle ScholarPubMed
2. Brown, DW, Gauvreau, K, Powell, AJ, et al. Cardiac magnetic resonance versus routine cardiac catheterization before bidirectional Glenn anastomosis in infants with functional single ventricle: a prospective randomized trial. Circulation 2007; 116: 2718–2725.CrossRefGoogle ScholarPubMed
3. Brown, DW, Gauvreau, K, Powell, AJ, et al. Cardiac magnetic resonance versus routine cardiac catheterization before bidirectional Glenn anastomosis: long-term follow-up of a prospective randomized trial. J Thorac Cardiovasc Surg 2013; 146: 1172–1178.CrossRefGoogle ScholarPubMed
4. Muthurangu, V, Taylor, AM, Hegde, SR, et al. Cardiac magnetic resonance imaging after stage I Norwood operation for hypoplastic left heart syndrome. Circulation 2005; 112: 3256–3263.CrossRefGoogle Scholar
5. Odenwald, T, Quail, MA, Giardini, A, et al. Systemic to pulmonary collateral blood flow influences early outcomes following the total cavopulmonary connection. Heart 2012; 98: 934–940.CrossRefGoogle ScholarPubMed
6. Stockton, E, Hughes, M, Broadhead, M, Taylor, A, McEwan, A. A prospective audit of safety issues associated with general anesthesia for pediatric cardiac magnetic resonance imaging. Paediatr Anaesth 2012; 22: 1087–1093.CrossRefGoogle ScholarPubMed
7. Pettersen, MD, Du, W, Skeens, ME, Humes, RA. Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr 2008; 21: 922–934.CrossRefGoogle Scholar
8. Hughes, ML, Tsang, VT, Kostolny, M, et al. Lessons from inter-stage cardiac magnetic resonance imaging in predicting survival for patients with hypoplastic left heart syndrome. Cardiol Young 2011; 21: 646–653.CrossRefGoogle ScholarPubMed
9. Lemler, MS, Zellers, TM, Harris, KA, Ramaciotti, C. Coarctation index: identification of recurrent coarctation in infants with hypoplastic left heart syndrome after the Norwood procedure. Am J Cardiol 2000; 86: 697–699; A699.CrossRefGoogle ScholarPubMed
10. Alsoufi, B, Manlhiot, C, Al-Ahmadi, M, et al. Older children at the time of the Norwood operation have ongoing mortality vulnerability that continues after cavopulmonary connection. J Thorac Cardiovasc Surg 2011; 142: 142–147 e142.CrossRefGoogle ScholarPubMed
11. Friedman, KG, Salvin, JW, Wypij, D, et al. Risk factors for failed staged palliation after bidirectional Glenn in infants who have undergone stage one palliation. Eur J Cardiothorac Surg 2011; 40: 1000–1006.Google ScholarPubMed
12. Tanoue, Y, Kado, H, Boku, N, et al. Three hundred and thirty-three experiences with the bidirectional Glenn procedure in a single institute. Interact Cardiovasc Thorac Surg 2007; 6: 97–101.CrossRefGoogle Scholar
13. Kaneko, S, Khoo, NS, Smallhorn, JF, Tham, EB. Single right ventricles have impaired systolic and diastolic function compared to those of left ventricular morphology. J Am Soc Echocardiogr 2012; 25: 1222–1230.CrossRefGoogle ScholarPubMed
14. Kogon, BE, Plattner, C, Leong, T, Simsic, J, Kirshbom, PM, Kanter, KR. The bidirectional Glenn operation: a risk factor analysis for morbidity and mortality. J Thorac Cardiovasc Surg 2008; 136: 1237–1242.CrossRefGoogle ScholarPubMed
15. Januszewska, K, Kozlik-Feldmann, R, Kordon, Z, et al. Significance of the residual aortic obstruction in multistage repair of hypoplastic left heart syndrome. Eur J Cardiothorac Surg 2011; 40: 508–513.Google ScholarPubMed
16. Larrazabal, LA, Selamet Tierney, ES, Brown, DW, et al. Ventricular function deteriorates with recurrent coarctation in hypoplastic left heart syndrome. Ann Thorac Surg 2008; 86: 869–874; discussion 869–874.CrossRefGoogle ScholarPubMed
17. Lee, TM, Aiyagari, R, Hirsch, JC, Ohye, RG, Bove, EL, Devaney, EJ. Risk factor analysis for second-stage palliation of single ventricle anatomy. Ann Thorac Surg 2012; 93: 614–618; discussion 619.CrossRefGoogle ScholarPubMed
18. Carlo, WF, Carberry, KE, Heinle, JS, et al. Interstage attrition between bidirectional Glenn and Fontan palliation in children with hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2011; 142: 511–516.CrossRefGoogle ScholarPubMed
19. Honjo, O, Atlin, CR, Mertens, L, et al. Atrioventricular valve repair in patients with functional single-ventricle physiology: impact of ventricular and valve function and morphology on survival and reintervention. J Thorac Cardiovasc Surg 2011; 142: 326–335, e322.CrossRefGoogle ScholarPubMed
20. Honjo, O, Mertens, L, Van Arsdell, GS. Atrioventricular valve repair in patients with single-ventricle physiology: mechanisms, techniques of repair, and clinical outcomes. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2011; 14: 75–84.CrossRefGoogle ScholarPubMed
21. Photiadis, J, Urban, AE, Sinzobahamvya, N, et al. Restrictive left atrial outflow adversely affects outcome after the modified Norwood procedure. Eur J Cardiothorac Surg 2005; 27: 962–967.CrossRefGoogle ScholarPubMed
22. Jones, BO, Ditchfield, MR, Cahoon, GD, et al. Cardiac magnetic resonance imaging prior to bidirectional cavopulmonary connection in hypoplastic left heart syndrome. Heart Lung Circ 2010; 19: 535–540.CrossRefGoogle ScholarPubMed