Abstract
To compare contrast-enhanced magnetic resonance angiography (ceMRA) and 3D steady-state free precession (SSFP) during systole and diastole for assessment of the right ventricle outflow tract (RVOT) in patients considered for percutaneous pulmonary valve implantation (PPVI) after tetralogy of Fallot (TOF) repair. We retrospectively evaluated 89 patients (male: 45, mean age 19 ± 8 years), who underwent cardiac-MRI after surgical TOF-repair. Datasets covering the whole heart in systole and diastole were acquired using ECG-gated 3D SSFP and non-gated ceMRA. Measurements were performed in SSFP-sequences and in ceMRA in the narrowest region of the RVOT to obtain the minimum, maximum and effective diameter. Invasive balloon sizing as the gold standard was available in 12 patients. The minimum diameter in diastolic SSFP, systolic SSFP and ceMRA were 21.4 mm (± 6.1 mm), 22.6 mm (± 6.2 mm) and 22.6 mm (± 6.0 mm), respectively. Maximum diameter was 29.9 mm (± 9.5 mm), 30.0 mm (± 7.0 mm) and 28.8 mm (± 8.1 mm) respectively. The effective diameter was 23.2 mm (± 5.7 mm), 27.4 mm (± 6.7 mm) and 24.4 mm (± 6.2 mm), differing significantly between diastole and systole (p < 0.0001). Measurements in ECG-gated SSFP showed a better inter- and intraobserver variability compared to measurements in non-ECG-gated ceMRA. Comparing invasive balloon sizing with our analysis, we found the highest correlation coefficients for the maximum and effective diameter measured in systolic SSFP (R = 0.99 respectively). ECG-gated 3D SSFP enables the identification and characterization of a potential landing zone for PPVI. The maximum and effective systolic diameter allow precise sizing for PPVI. Patients with TOF-repair could benefit from cardiac MRI before PPVI.
Highlights
Patients after surgical repair of tetralogy of Fallot (TOF) often suffer from pulmonary regurgitation (PR) or residual pulmonary stenosis (PS)
The purpose of our study is to determine which CMRtechnique is better suited for the assessment of the right ventricle outflow tract (RVOT) in patients after TOF-repair considered for Percutaneous pulmonary valve implantation (PPVI): breathhold contrast-enhanced MR-angiography or free-breathing navigator and ECG-gated 3D steady-state free precession (3D-SSFP) sequence, acquired during systole and diastole
This study shows that Cardiac magnetic resonance imaging (CMR) is a suitable technique for preprocedural assessment of the RVOT and for sizing before
Summary
Patients after surgical repair of tetralogy of Fallot (TOF) often suffer from pulmonary regurgitation (PR) or residual pulmonary stenosis (PS). Althougn state-of-the-art-surgery of PI and PS in patients after TOF-repair has low mortality [2, 3], valve-carryingconduits, have a limited lifespan of < 10 years so that the majority of the patients undergo multiple re-operations [4,5,6,7]. Percutaneous pulmonary valve implantation (PPVI) is a new treatment for PS and PR with excellent early and late results [8,9,10], it could help to delay surgery by prolonging conduit lifespan and reducing the number of operations on the open heart. It can be challenging to decide which patients are suitable for PPVI by using 2D-methods due to the complex 3D-anatomy of the right ventricle outflow tract (RVOT), especially after surgery.
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