Interventional Cardiovascular Magnetic Resonance Imaging (iCMR) in an Adolescent with Pulmonary Hypertension

Surendranath R Veeram Reddy,Tarique Hussain,Yousef Arar,Bibhuti B Das,Gerald Greil,Luis Zabala

doi:10.3390/medicina56120636

Surendranath R Veeram Reddy, Tarique Hussain + Show 4 more

Open Access

https://doi.org/10.3390/medicina56120636

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Abstract

The interventional cardiac magnetic resonance imaging (iCMR) catheterization procedure is feasible and safe for children and adults with pulmonary hypertension and congenital heart defects (CHD). With iCMR, the calculation of pulmonary vascular resistance (PVR) in children with complex CHD with multilevel shunt lesions is accurate. In this paper, we describe the role of the MRI-guided right-sided cardiac catheterization procedure to accurately estimate PVR in the setting of multiple shunt lesions (ventricular septal defect and patent ductus arteriosus) and to address the clinical question of operability in an adolescent with trisomy 21 and severe pulmonary hypertension.

Highlights

Pediatric pulmonary hypertension (PH) in children is a complex heterogeneous disease and differs from adults in many respects in etiology and outcomes
Flow analysis regarding and catheter-measured transpulmonary gradient, heart an thereby allowing for correct critical decisions the operability of complex congenital accurate can In bethis calculated, thereby allowing for correct decisions regarding the disease patients paper, we describe the feasibility and critical usefulness of CMR-guided operability of complex congenital heart disease
Total pulmonary blood flow assessment was done by summing the flow in the right pulmonary artery (RPA) and the left pulmonary artery (LPA) distal to patent ductus arteriosus (PDA) entrance, the approach based on the assumption that total pulmonary flow can be more accurately quantified by measuring flow in each branch artery [9]

Summary

Introduction

Pediatric pulmonary hypertension (PH) in children is a complex heterogeneous disease and differs from adults in many respects in etiology and outcomes. Due to cumulative radiation exposure and, most importantly, the unpredictable nature of Fick’s principle-based pulmonary blood flow calculation in complex cardiac conditions with multiple left-to-right shunts, it makes RHC not an ideal tool for PH evaluation and serial follow-up. Standard RHC to measure accurate pulmonary blood flow poses a significant challenge in patients with multiple left-to-right shunts as the position of catheter and Medicina 2020, 56, 636; doi:10.3390/medicina56120636 www.mdpi.com/journal/medicina. Will significantly influence shunts the pulmonary arterial blood flow a significant patients with multiple left-to-right as the position saturation that is plugged into the. Any minor change in pulmonary arterial saturations related to the patient’s anatomy or provides accurate pulmonary blood flow calculations and is independent of confounding variables operator technique will significantly influence the total pulmonary blood flow and resultant related to catheter-based. Institutional Review Board (IRB) (STU 032017–061; approved 1 March 2017)

Case Report

Echocardiography demonstrating apical

Findings

Discussion

Conclusions