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Role of MRI in TOF follow-up

Role of MRI in TOF follow-up. TOF symposium October 25, 2013 Dr Edythe Tham. Outline. Quantification of RV size & function Quantification of pulmonary regurgitation Pulmonary stenosis Branch pulmonary arteries Conduits and artificial valves. Goals of cardiac MRI.

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Role of MRI in TOF follow-up

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  1. Role of MRI in TOF follow-up TOF symposium October 25, 2013 Dr Edythe Tham

  2. Outline Quantification of RV size & function Quantification of pulmonary regurgitation Pulmonary stenosis Branch pulmonary arteries Conduits and artificial valves

  3. Goals of cardiac MRI • Quantification of RV & LV volumes and function (RVEF) • Quantification of pulmonary regurgitant fraction (RF) • Anatomy of the RVOT & branch pulmonary arteries (and aorta) • Assessment of myocardial fibrosis

  4. RV volumes

  5. Pulmonary regurgitation Transannular patch

  6. RVOT

  7. Flow Quantification: Phase contrast imaging

  8. Pulmonary Regurgitation Region of interest

  9. Regurgitant fraction

  10. Criteria for pulmonary valve replacement • RVEDV >170 ml/m2 • RVESV > 85 ml/m2 • RVEF < 45% • Regurgitant Fraction >30% Therrien et al, AJC 2005

  11. Relationship between RV volume and pulmonary regurgitation Samyn et al, JMRI 2007

  12. Relationship between RV ESV & RVEF Geva et al, JACC 2004

  13. 17 year female, S/P TAP RVEDVi 111 ml/m2 RVESVi 56 ml/m2 RVEF 50% LVEF 60%

  14. Regurgitant Fraction 43%

  15. 11 year female with TOF/PAS/P RV-PA conduit RVEDVi 178 ml/m2 RVESVi 150 ml/m2 RVEF 16% LVEF 28%

  16. Normal septal curvature TOF

  17. Regurgitant fraction 57% Peak velocity 2 m/s = Peak gradient 16 mmHg

  18. Pulmonary stenosis

  19. 10 year female S/P TAP Mixed disease – Mild PS: 20 mmHg Moderal PR: 34%

  20. Magnetic Resonance Angiography Branch pulmonary arteries

  21. 21 year male S/P TOF repair RPA 56%: LPA 44% Mild proximal LPA stenosis, PG 25 mmHg

  22. 18 year old S/P TOF repair – bilateral branch PA stenosis RPA 75%: LPA 25% Peak gradients: RPA: 38 mmHg LPA: 29 mmHg

  23. 12 year female with branch PA stenosis From MRI RPA 82%: LPA 18%

  24. Left pulmonary artery Right pulmonary artery

  25. RVOT aneurysm

  26. RVOT aneurysm

  27. Conduits & artificial valves

  28. Artifact from prosthetic valve • 12 year female • Prosthetic pulmonary valve • Melody valve

  29. 38 year male S/P 29 mm Hancock valve RVEDVi 170 ml/m2 RVESVi 98 ml/m2 RVEF 42% RF 20% Peak velocity 3 m/s = PG 36 mmHg

  30. Melody valve

  31. Circulation, 2006;113:405-413

  32. RVEF 33%

  33. Indications for cardiac MRI • Baseline post-TOF repair at 7-10 years (no sedation required) • Follow up every 1-3 years depending on clinical status • Yearly MRI if: symptomatic or evidence of RV dysfunction

  34. Cardiac MRI: Disadvantages Not portable Contraindications: pacemaker/AICD Affected by metallic artifacts eg prosthetic valves, stents

  35. Advantages of MRI No radiation Does not require sedation in older children Independent of acoustic windows Capability for 3D reconstruction Quantifies ventricular function Flow quantification

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