AUTHOR: Geva T; Rokey R; Wendt RE; Vick GW 3rd
COMMENTS:
Comment in: Circulation 1995 Feb 1;91(3):906-8
ABSTRACT:
BACKGROUND: Patients with heterotaxy syndrome frequently have
complex congenital cardiac and noncardiac malformations requiring
detailed diagnostic evaluation by noninvasive as well as invasive
imaging modalities for management planning. Recent advances in
magnetic resonance imaging (MRI) techniques allow detailed
delineation of cardiovascular anatomy and blood flow in young
infants with rapid heart rates. The present study was undertaken
to prospectively evaluate the role of MRI in the presurgical
evaluation of patients with heterotaxy syndrome. METHODS AND
RESULTS: Between January 1 and December 31, 1992, 14 consecutive
patients with heterotaxy syndrome and complex congenital heart
disease were enrolled in a prospective protocol. After evaluation
by echocardiography and cardiac catheterization, a tentative
management plan was recorded. Subsequently, a MRI study was
performed and surgical planning was reevaluated. MRI was found to
be comparable to echocardiography in terms of length of
examination and sedation requirements. Surgical planning was
altered in four patients because MRI provided additional data not
evident on echocardiography and catheterization. Comparison of
diagnostic yield between echocardiography, catheterization, and
MRI showed that MRI is superior to echocardiography and often to
catheterization in delineation of systemic and pulmonary venous
anatomy and their relation to mediastinal structures. When the
anatomic and hemodynamic data obtained by echocardiography and
MRI were considered together, cardiac catheterization data were
necessary only to determination of pulmonary vascular resistance
before Fontan operation. CONCLUSIONS: MRI provides excellent
anatomic and functional information that in some patients was not
available by echocardiography or catheterization. Combined with
echocardiography, MRI provides the high-quality diagnostic
information necessary for management planning in most patients
with heterotaxy syndrome. Cardiac catheterization is indicated
when determination of pulmonary vascular resistance is necessary
for decision making or when an interventional procedure is
indicated.
SOURCE: Circulation 1994 Jul;90(1):348-56
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