Congenital Heart Disease

Pamela K. Woodard1, Jie Zheng1

1 Mallinckrodt Institute of Radiology, Washington University Medical Center, St. Louis, Missouri
Publication Name:  Current Protocols in Magnetic Resonance Imaging
Unit Number:  Unit A10.1
DOI:  10.1002/0471142719.mia1001s00
Online Posting Date:  May, 2001
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Abstract

Cardiac MRI plays a pivotal role in both anatomical and functional assessment of shunts, admixture lesions, transpositions, and the surgical correction of these lesions. This unit presents basic techniques for the evaluation of congenital heart disease. While sequence parameters described are meant to be as generic as possible, parameters are most appropriate for the Siemens 1.5 T Vision or Symphony, and may need to be altered for magnets of different field strengths and manufacturers.

     
 
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Table of Contents

  • Unit Introduction
  • Basic Protocol 1: Imaging Congenital Heart Disease
  • Alternate Protocol 1: Intracardiac Shunt Assessment
  • Alternate Protocol 2: Valve Assessment
  • Basic Protocol 2: Associated Great Vessel Assessment
  • Commentary
  • Bibliography
  • Figures
  • Tables
     
 
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Materials

Basic Protocol 2: Associated Great Vessel Assessment

 Materials
  • Normal saline (0.9% NaCl), sterile
  • Gadolinium-based MR contrast agent (e.g., Magnevist, Omniscan, Prohance, or OptiMARK)
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Figures

  •  FigureFigure A10.1.1 Transaxial black blood HASTE (A) and cine GRE (B) images at the same cardiac level. Image from the cine sequence demonstrates the jet from a small membranous ventricular septal defects (VSD; arrow). The VSD cannot be identified on the static black-blood images (RV, right ventricle; LV, left ventricle).
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  •  FigureFigure A10.1.2 Multiple orthogonal views can be prescribed from initial images. Here a transaxial black blood image (A) was used to set up a long-axis two-chamber view (B). The long-axis view was then used to set up a horizontal long-axis view (C) of the heart. (RV, right ventricle, LV, left ventricle).
    View Image
  •  FigureFigure A10.1.3 Image from a bright-blood cine GRE sequence shows a small patent ductus arteriosus (PDA) connecting the descending aorta and the main pulmonary artery. An arrow points to a small jet. This PDA was barely visible on black-blood anatomic MR imaging.
    View Image
  •  FigureFigure A10.1.4 Horizontal long-axis black-blood image can be used to set up multiple short-axis cine sequences that can be used to provide information about left ventricular function. (RV, right ventricle; LV, left ventricle).
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  •  FigureFigure A10.1.5 Cine GRE images demonstrate post-stenotic dephasing. (A) A coronal image shows a domed, bicuspid aortic valve. A jet (arrow) indicates stenosis. (B) In the same patient, the black area of post-stenotic dephasing or jet (arrow) can be identified on a transaxial cine image. (C) A double-oblique image through the pulmonic valve in a patient with tetralogy of Fallot shows a jet (arrow) distal to subpulmonic soft tissue, indicative of infundibular subpulmonic stenosis.
    View Image

Videos

Literature Cited

 Literature Cited
    Chatzimavroudis, G.P., Walker, P.G., Oshinski, J.N., Franch, R.H., Pettigrew, R.I., and Yoganathan, A.P. 1997. Slice location dependence of aortic regurgitation measurements with MR phase velocity mapping. Magn. Reson. Med. 37(4):545-551.
    Didier, D. and Higgins, C.B. 1986. Identification and localization of ventricular septal defect by gated magnetic resonance imaging. Am. J. Cardiol. 57:1363-1368.
    Didier, D., Ratib, O., Lerch., and Friedli, B. 2000. Detection and quantification of valvular heart disease with dynamic cardiac MR imaging. Radiographics 20:1279-1299.
    Higgins, C.B. 2000. Cardiac imaging. Radiology 217:4-10.
    Sechtem, U., Pflugfelder, P., Cassidy, M.C., Holt, W., Wolfe, C., and Higgins, C.B. 1987. Ventricular septal defect: Visualization of shunt flow and determination of shunt size by cine MR imaging. AJR Am. J.Roentgenol. 149:689-692.
    Shellock, F.G. 1999. Pocket Guide to MR Procedures and Metallic Objects. Lippincott-Raven, Philadelphia.
 Key References
    Chen, J.T.T. 1997. Essentials of Cardiac Imaging, 2nd ed. Lippincott-Raven, Philadelphia.

This textbook is an excellent reference for the interpretation of all congenital heart imaging, going over the anatomy, physiology and embryology of each congenital heart defect in detail.

    Higgins, 2000. See above.

Provides an overview of multiple modalities and their uses in cardiac imaging, including cardiac MR.

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