Magnetic resonance and echocardiographic imaging of pulmonary artery size throughout stages of Fontan reconstruction.
نویسندگان
چکیده
BACKGROUND Because pulmonary artery size is considered by most investigators to be a major prognosticator of outcome in patients undergoing staged Fontan reconstruction, the objective of the present study was to determine the efficacy of noninvasive measures in determining pulmonary artery size. METHODS AND RESULTS This study analyzed the T1-weighted, spin-echo magnetic resonance and echocardiographic images of 36 functional single-ventricle patients throughout stages of Fontan reconstruction (prebidirectional and postbidirectional cavopulmonary anastomosis and after Fontan) and compared them with angiography images at cardiac catheterization. Magnetic resonance imaging had a high degree of agreement with angiography, with the McGoon index agreeing better than the Nakata index and absolute right and left pulmonary diameters. Although echocardiography had fair agreement with angiography, it agreed less well and had a wider standard deviation than magnetic resonance imaging for all indexes and measurements and, based on the prediction interval, would be a poorer prospective measure of pulmonary artery size in this population. In addition, echocardiography was a poorer measure of pulmonary artery size as the size of the vessel increases. Magnetic resonance imaging correctly detected five of five patients with nonconfluent branch pulmonary arteries and six of six patients with stenoses, whereas echocardiography was unable to visualize any of the patients with nonconfluent branch pulmonary arteries with certainty and only two of six (33%) with stenoses. CONCLUSIONS Magnetic resonance imaging is a useful, noninvasive tool to determine pulmonary artery size in patients undergoing Fontan reconstruction and is superior to echocardiography. Echocardiography was a fair predictor of pulmonary artery size, but magnetic resonance imaging agreed with angiography better than echocardiography and outperformed echocardiography in diagnosing branch pulmonary artery discontinuity and stenoses. Magnetic resonance imaging may avoid unnecessary cardiac catheterization, especially in older patients, and may obviate the need for jugular or subclavian catheterization in those who have undergone bidirectional cavopulmonary anastomosis.
منابع مشابه
Cardiac magnetic resonance of single ventricles.
The assessment of the patient with a single ventricle is an enormous challenge to medical science. Not only are there are varied types of single ventricles, nearly all patients require either heart replacement or reconstructive surgery, including an aortic to pulmonary connection. During the various phases of reconstructive surgeries which eventually leads to the Fontan procedure (1), there are...
متن کاملRelationship between Late Gadolinium Enhancement Extent in Cardiac Magnetic Resonance Imaging and Severity of Coronary Artery Disease in Old Myocardial Infarction
Purpose: To assess the relationship between the severity of coronary arteries involvement and the extent and pattern of myocardial scars in Cardiac Magnetic Resonance of patients with history of remote myocardial infarction. Materials and Methods: The Cardiac Magnetic Resonance images of sixty patients with history of remote ST segment or non-ST segment elevation myocardial infarction were ...
متن کاملDetection of right atrial and pulmonary artery thrombosis after the Fontan procedure by magnetic resonance imaging.
T he Fontan procedure has been extensively used for palliation of patients with univentricular heart defects. Thrombi and thromboembolic complications have been frequently reported after this operation. Magnetic resonance imaging (MRI) has been shown to be very useful in patients with congenital heart disease and also in the detection of intracardiac masses and thrombosis. We describe for the f...
متن کاملSildenafil improves exercise hemodynamics in Fontan patients.
BACKGROUND Patients with Fontan circulation have reduced exercise capacity. The absence of a presystemic pump may limit flow through the pulmonary circulation, restricting ventricular filling and cardiac output. We evaluated exercise hemodynamics and the effect of sildenafil on exercise hemodynamics in Fontan patients. METHODS AND RESULTS Ten Fontan patients (6 men, 20±4 years) underwent card...
متن کاملEvaluation of the extracardiac conduit modification of the Fontan operation for thrombus formation using magnetic resonance imaging.
BACKGROUND The prevalence of thrombosis after the Fontan procedure depends upon the surgical technique used and the method of detection employed. Current investigations for thrombosis lack sensitivity and specificity or, in the paediatric population, require a general anaesthetic. We undertook a study to examine the feasibility of using magnetic resonance imaging (MRI) to detect thrombosis with...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Circulation
دوره 90 6 شماره
صفحات -
تاریخ انتشار 1994