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The comparative role of echocardiography and MRI for identifying critical lesions in patients with single-ventricle physiology, before bidirectional cavopulmonary connection

Published online by Cambridge University Press:  04 February 2016

Sylvia Krupickova ,
Michael A. Quail ,
Robert Yates ,
Roman Gebauer ,
Marina Hughes  and
Jan Marek
Sylvia Krupickova
Affiliation:
Cardiorespiratory Unit, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, London, United Kingdom
Michael A. Quail
Affiliation:
Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, London, United Kingdom
Robert Yates
Affiliation:
Cardiorespiratory Unit, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, London, United Kingdom
Roman Gebauer
Affiliation:
Children’s Heart Centre, University Hospital Motol, Prague, Czech Republic
Marina Hughes
Affiliation:
Cardiorespiratory Unit, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, London, United Kingdom Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, London, United Kingdom
Jan Marek*
Affiliation:
Cardiorespiratory Unit, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, London, United Kingdom Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, London, United Kingdom
*
Correspondence to: Professor J. Marek, Consultant Paediatric Cardiologist, Lead of Echocardiography Department, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, United Kingdom. Tel: +44 20 7762 5000; Fax: +44 20 7829 8673; E-mail: [email protected]
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Abstract

Background

In the era of multi-modality imaging, this study compared contemporary, pre-operative echocardiography and cardiac MRI in predicting the need for intervention on additional lesions before surgical bidirectional cavopulmonary connection.

Methods

A total of 72 patients undergoing bidirectional cavopulmonary connection for single-ventricle palliation between 2007 and 2012, who underwent pre-operative assessment using both echocardiography and MRI, were included. The pre-determined outcome measure was any additional surgical or catheter-based intervention within 6 months of bidirectional cavopulmonary connection. Indices assessed were as follows: indexed dimensions of right and left pulmonary arteries, coarctation of the aorta, adequacy of interatrial communication, and degree of atrioventricular valve regurgitation.

Results

Median age at bidirectional cavopulmonary connection was 160 days (interquartile range 121–284). The following MRI parameters predicted intervention: Z score for right pulmonary artery (odds ratio 1.77 (95% confidence interval 1.12–2.79, p=0.014)) and left pulmonary artery dimensions (odds ratio 1.45 (1.04–2.00, p=0.027)) and left pulmonary artery report conclusion (odds ratio 1.57 (1.06–2.33)). The magnetic resonance report predicted aortic arch intervention (odds ratio 11.5 (3.5–37.7, p=0.00006)). The need for atrioventricular valve repair was associated only with magnetic resonance regurgitation fraction score (odds ratio 22.4 (1.7–295.1, p=0.018)). Echocardiography assessment was superior to MRI for predicting intervention on interatrial septum (odds ratio 27.7 (6.3–121.6, p=0.00001)).

Conclusion

For branch pulmonary arteries, aortic arch, and atrioventricular valve regurgitation, MRI parameters more reliably predict the need for intervention; however, echocardiography more accurately identified the adequacy of interatrial communication. Approaching bidirectional cavopulmonary connection, the diagnostic strengths of MRI and echocardiography should be acknowledged when considering intervention.

Keywords

Bidirectional cavopulmonary connectionechocardiographycardiac magnetic resonance
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 7 , October 2016 , pp. 1373 - 1382
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Copyright
© Cambridge University Press 2016 

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Footnotes

*

Authors contributed equally.

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