Cardiovascular Magnetic Resonance catheterization derived pulmonary vascular resistance and medium-term outcomes in congenital heart disease

Journal of Cardiovascular Magnetic Resonance

Research

Aaron Bell¹  Hannah R Bellsham-Revell¹  Tobias Schaeffter²  James K Wong²  Israel Valverde²  Aphrodite Tzifa²  Kuberan Pushparajah³  Tarique Hussain³  Reza Razavi³  Gerald Greil³  John M Simpson³ 

[1] Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK;Division of Imaging Sciences, King’s College London BHF Centre, NIHR Biomedical Research Centre at Guy’s & St Thomas’ NHS Foundation Trust, Westminster Bridge Rd, SE1 7EH, London, UK;Division of Imaging Sciences, King’s College London BHF Centre, NIHR Biomedical Research Centre at Guy’s & St Thomas’ NHS Foundation Trust, Westminster Bridge Rd, SE1 7EH, London, UK;Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK;

关键词: Cardiovascular magnetic resonance;    Catheterization;    Pulmonary vascular resistance;    Interventional cardiovascular magnetic resonance;    Congenital heart disease;   

DOI  :  10.1186/s12968-015-0130-4

 received in 2014-08-13, accepted in 2015-03-13,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundSelection of patients with congenital heart disease for surgical septation in biventricular repair or surgical palliation in functionally single ventricles requires low pulmonary vascular resistance (PVR). Where there is uncertainty, PVR can be assessed using hybrid cardiovascular magnetic resonance (CMR) and fluoroscopic (X-Ray) guided cardiac catheterizations (XMR). CMR/XMR catheterization is a validated technique for accurate assessment of pulmonary vascular resistance. However, data concerning its application in clinical practice is lacking.MethodsPVR assessments were performed in 167 studies in 149 congenital heart disease patients by CMR/XMR catheterization. Data was collated on patient demographics, procedural data, complications and outcomes. Institutional ethics approval was obtained.ResultsMedian age was 3.6 years (6 days - 67 years) and weight 13.8 kg (2.3 -122 kg). One hundred and eight studies were in biventricular circulations and 59 in functionally single ventricles. Median radiation dose was 0.72 mSv. A baseline Qp:Qs ≤2.75 in biventricular circulations with left-to-right shunts predicted a PVR ≥6 WU.m2 with 100% sensitivity and 48% specificity. Median follow up until death or last review was 4.2 years (4 days - 11 years). Eighty-four patients had a surgical or catheter intervention based on CMR/XMR catheterization findings at a median of 94 days after the study. This included successful biventricular repair at resting PVR values ≤6 WU.m2 and Fontan completion at ≤4 WU.m2.ConclusionPVR measured by CMR/XMR catheterization allows accurate stratification for intervention in patients with congenital heart disease in both, biventricular and univentricular circulations.

【 授权许可】

Unknown   
© Pushparajah et al.; licensee BioMed Central. 2015. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.