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Molossi S, Sachdeva S. Advice to Young Athletes With Anomalous Aortic Origin of a Coronary Artery With and Without Surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2025; 28:83-93. [PMID: 40382130 DOI: 10.1053/j.pcsu.2025.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Revised: 01/13/2025] [Accepted: 01/18/2025] [Indexed: 05/20/2025]
Abstract
Congenital coronary artery anomalies remain a leading cause of sudden cardiac death in the young. Within these, anomalous aortic origin of a coronary artery represents the largest group, with anomalies of the left coronary artery carrying higher risk for sudden cardiac arrest and clinical manifestations of myocardial ischemia. In contrast, anomalies of origin of the right coronary artery are more common and generally have a more benign clinical course, though rarely also associated with sudden events and myocardial ischemia. Risk stratification to guide management decisions remains to be well defined, though substantial advances have occurred in the last few years, with assessment of myocardial perfusion under provocative stress being an integral part of the evaluation in the young. Discussion and counseling on exercise behavior is essential to foster healthy lifestyle for these patients, acknowledging shared decision-making should be practiced in lieu of many unanswered questions as to outcomes long-term.
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Affiliation(s)
- Silvana Molossi
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas; The Lillie Frank Abercrombie Division of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
| | - Shagun Sachdeva
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas; The Lillie Frank Abercrombie Division of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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2
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Voges I, Raimondi F, McMahon CJ, Ait-Ali L, Babu-Narayan SV, Botnar RM, Burkhardt B, Gabbert DD, Grosse-Wortmann L, Hasan H, Hansmann G, Helbing WA, Krupickova S, Latus H, Martini N, Martins D, Muthurangu V, Ojala T, van Ooij P, Pushparajah K, Rodriguez-Palomares J, Sarikouch S, Grotenhuis HB, Greil FG, Bohbot Y, Cikes M, Dweck M, Donal E, Grapsa J, Keenan N, Petrescu AM, Szabo L, Ricci F, Uusitalo V. Clinical impact of novel cardiovascular magnetic resonance technology on patients with congenital heart disease: a scientific statement of the Association for European Pediatric and Congenital Cardiology and the European Association of Cardiovascular Imaging of the European Society of Cardiology. Eur Heart J Cardiovasc Imaging 2024; 25:e274-e294. [PMID: 38985851 DOI: 10.1093/ehjci/jeae172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR) imaging is recommended in patients with congenital heart disease (CHD) in clinical practice guidelines as the imaging standard for a large variety of diseases. As CMR is evolving, novel techniques are becoming available. Some of them are already used clinically, whereas others still need further evaluation. In this statement, the authors give an overview of relevant new CMR techniques for the assessment of CHD. Studies with reference values for these new techniques are listed in the Supplementary data online, supplement.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Kiel, Germany
| | | | - Colin J McMahon
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - Lamia Ait-Ali
- Institute of Clinical Physiology CNR, Massa, Italy
- Heart Hospital, G. Monastery foundation, Massa, Italy
| | - Sonya V Babu-Narayan
- Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - René M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
- Institute for Biological and Medical Engineering and School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Barbara Burkhardt
- Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Dominik D Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Kiel, Germany
| | - Lars Grosse-Wortmann
- Division of Cardiology, Oregon Health and Science University Hospital, Portland, OR, USA
| | - Hosan Hasan
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
- European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
- European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Willem A Helbing
- Department of Pediatrics, Division of Cardiology, and Department of Radiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sylvia Krupickova
- Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Department of Paediatric Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Heiner Latus
- Clinic for Pediatric Cardiology and Congenital Heart Disease Klinikum, Stuttgart Germany
| | - Nicola Martini
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- U.O.C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Duarte Martins
- Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Vivek Muthurangu
- Centre for Translational Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK
| | - Tiina Ojala
- New Children's Hospital Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Jose Rodriguez-Palomares
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, The Netherlands
- Servicio de Cardiología, Hospital Universitario Vall Hebrón, Institut de Recerca Vall Hebrón (VHIR), Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Samir Sarikouch
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Heynric B Grotenhuis
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Gerald Greil
- Department of Pediatrics, UT Southwestern/Children's Health, Dallas, TX, USA
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Beattie M, Beroukhim R, Annese D, Dionne A, Baker A, Powell AJ. Coronary Events Following Dobutamine Stress Cardiac Magnetic Resonance Imaging in Pediatric Patients. Pediatr Cardiol 2024:10.1007/s00246-024-03632-4. [PMID: 39172254 DOI: 10.1007/s00246-024-03632-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 08/14/2024] [Indexed: 08/23/2024]
Abstract
Dobutamine stress cardiac magnetic resonance (dsCMR) has demonstrated value in identifying patients at risk for adverse cardiovascular events in adults with coronary artery disease, but its prognostic value in younger patients is unknown. This study sought to evaluate the relationship between dsCMR results and the risk of subsequent cardiovascular events in children. Patients age < 23 years who underwent dsCMR at Boston Children's Hospital were eligible for inclusion. Patients were excluded if no follow-up data were available after dsCMR or the dsCMR protocol was not completed. Data regarding the presence of inducible regional wall motion abnormalities and subsequent cardiovascular events during follow-up were analyzed. Cardiovascular events included myocardial infarction, surgical or catheter-based coronary artery intervention, and ischemic symptoms. Among 80 dsCMR studies in 64 patients with median age 5.3 years (range 0.5-22.4 years), 3 patients had a positive dsCMR with inducible regional wall motion abnormalities. Over a median follow-up of 7.4 years (IQR 4.0-11.2), 2 of these patients underwent surgical intervention (coronary artery bypass grafting and unroofing of a myocardial bridge) and the third remained asymptomatic with no interventions. Among 61 patients with a negative dsCMR, none experienced myocardial infarction, death, or aborted sudden death. Four underwent cardiac interventions (cardiac transplantation, coronary artery bypass grafting, and unroofing) due to symptoms or catheterization findings. In pediatric patients undergoing dsCMR, wall motion abnormalities indicating inducible ischemia were uncommon. Those with a negative dsCMR were unlikely to experience an adverse cardiac event or undergo a cardiac intervention on medium-term follow-up.
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Affiliation(s)
- Meaghan Beattie
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
- Division of Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Rebecca Beroukhim
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - David Annese
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Annette Baker
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Molossi S, Doan T, Sachdeva S. Anomalous Coronary Arteries: A State-of-the-Art Approach. Card Electrophysiol Clin 2024; 16:51-69. [PMID: 38280814 DOI: 10.1016/j.ccep.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Congenital coronary anomalies are not an infrequent occurrence and their clinical presentation typically occurs during early years, though may be manifested only in adulthood. In the setting of anomalous aortic origin of a coronary artery, this is particularly concerning as it inflicts sudden loss of healthy young lives. Risk stratification remains a challenge and so does the best management decision-making in these patients, particularly if asymptomatic. Standardized approach to evaluation and management, with careful data collection and collaboration among centers, will likely impact future outcomes in this patient population, thus allowing for exercise participation and healthier lives.
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Affiliation(s)
- Silvana Molossi
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA.
| | - Tam Doan
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
| | - Shagun Sachdeva
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
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5
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Molossi S, Doan T, Sachdeva S. Anomalous Coronary Arteries: A State-of-the-Art Approach. Interv Cardiol Clin 2024; 13:51-70. [PMID: 37980067 DOI: 10.1016/j.iccl.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Congenital coronary anomalies are not an infrequent occurrence and their clinical presentation typically occurs during early years, though may be manifested only in adulthood. In the setting of anomalous aortic origin of a coronary artery, this is particularly concerning as it inflicts sudden loss of healthy young lives. Risk stratification remains a challenge and so does the best management decision-making in these patients, particularly if asymptomatic. Standardized approach to evaluation and management, with careful data collection and collaboration among centers, will likely impact future outcomes in this patient population, thus allowing for exercise participation and healthier lives.
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Affiliation(s)
- Silvana Molossi
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA.
| | - Tam Doan
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
| | - Shagun Sachdeva
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
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Lau WR, Lee PT, Koh CH. Coronary Artery Anomalies - State of the Art Review. Curr Probl Cardiol 2023; 48:101935. [PMID: 37433414 DOI: 10.1016/j.cpcardiol.2023.101935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023]
Abstract
Coronary artery anomalies (CAAs) comprise a wide spectrum of anatomic entities, with diverse clinical phenotypes. We present a case of an anomalous right coronary artery arising from the left aortic sinus with an interarterial course, a potentially fatal condition that can precipitate ischemia and sudden cardiac death. CAAs are increasingly detected in adults, mostly as incidental findings in the course of cardiac evaluation. This is due to the expanding use of invasive and noninvasive cardiac imaging, usually in the work-up for possible CAD. The prognostic implications of CAAs in this group of patients remain unclear. In AAOCA patients, appropriate work-up with anatomical and functional imaging should be performed for risk stratification. An individualized approach to management should be adopted, considering symptoms, age, sporting activities and the presence of high-risk anatomical features and physiologic consequences (such as ischemia, myocardial fibrosis, or cardiac arrhythmias) detected on multimodality imaging or other functional cardiac investigations. This comprehensive and up to date review seeks to crystallize current data in the recent literature, and proposes a clinical management algorithm for the clinician faced with the conundrum of managing such conditions.
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Affiliation(s)
- Wei Ren Lau
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Phong Teck Lee
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore
| | - Choong Hou Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore; Changi Aviation Medical Centre, Changi General Hospital, Singapore.
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7
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Gräni C, Bigler MR, Kwong RY. Noninvasive Multimodality Imaging for the Assessment of Anomalous Coronary Artery. Curr Cardiol Rep 2023; 25:1233-1246. [PMID: 37851270 DOI: 10.1007/s11886-023-01948-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE OF REVIEW Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital coronary anomaly with the potential to cause myocardial ischemia and adverse cardiac events. The presence of AAOCA anatomy itself does not necessarily implicate a need for revascularization. Therefore, the purpose of this review is to assess how noninvasive comprehensive anatomic- and physiologic evaluation may guide patient management. RECENT FINDINGS The assessment of AAOCA includes an accurate description of the anomalous origin/vessel course including anatomical high-risk features such as a slit-like ostium, proximal narrowing, elliptic vessel shape, acute take-off angle, intramural course, and possible concomitant coronary atherosclerosis and hemodynamics. Various cardiac imaging modalities offer unique advantages and capabilities in visualizing these anatomical and functional aspects of AAOCA. This review explored the role of noninvasive multimodality imaging in the characterization of AAOCA by highlighting the strengths, limitations, and potential applications of the current different cardiac imaging methods, with a focus on the pathophysiology of myocardial ischemia and stress testing protocols.
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Affiliation(s)
- Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marius R Bigler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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Zeppilli P, Bianco M, Gervasi SF, Cammarano M, Monti R, Sollazzo F, Modica G, Morra L, Nifosì FM, Palmieri V. Congenital coronary artery anomalies in sports medicine. Why to know them. Clin Cardiol 2023; 46:1038-1048. [PMID: 37432696 PMCID: PMC10540032 DOI: 10.1002/clc.24084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023] Open
Abstract
The anomalous origin of a coronary artery (AOCA) is a challenging topic, due to its rarity, the complexity of the pathophysiological aspects, the clinical presentation (often silent), the difficulty of diagnosis, and the potential risk of causing acute cardiovascular events up to sudden cardiac death, particularly when triggered by heavy physical exercise or sport practice. Increasing interest in sport medical literature is being given to this topic. This paper reviews current knowledge of AOCAs in the specific context of the athletic setting addressing epidemiological and pathophysiological aspects, diagnostic work-up, sports participation, individual risk assessment, therapeutic options, and return to play decision after surgery.
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Affiliation(s)
- Paolo Zeppilli
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Massimiliano Bianco
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Salvatore F. Gervasi
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Michela Cammarano
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Riccardo Monti
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Fabrizio Sollazzo
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Gloria Modica
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Lorenzo Morra
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Francesco M. Nifosì
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Vincenzo Palmieri
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
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Molossi S, Doan T, Sachdeva S. Anomalous Coronary Arteries. Cardiol Clin 2023; 41:51-69. [DOI: 10.1016/j.ccl.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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10
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Dobutamine Stress Cardiac MRI in Pediatric Patients with Suspected Coronary Artery Disease. Pediatr Cardiol 2023; 44:451-462. [PMID: 36129514 DOI: 10.1007/s00246-022-03007-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/07/2022] [Indexed: 02/07/2023]
Abstract
Following current practice, pediatric patients with treated congenital coronary malformations or acquired coronary disease undergo Cardio-Pulmonary Exercise Test (CPET), stress Echocardiography and Electrocardiography (sEcho, sEKG), and Coronary Angiography (CA). Stress cMRI can assess cardiac function, myocardial viability, and stress/rest perfusion deficit-without radiation exposure, general anesthesia, and hospitalization-in a single non-invasive exam. The aim of our pilot study is to assess the feasibility and diagnostic accuracy of Dobutamine stress cMRI compared to the current procedures (sEcho, CPET, CA). The prospective study is focused on pediatric patients, at risk for or with previously diagnosed coronary artery disease: d-looped TGA after arterial Switch, Kawasaki disease, and anomalous origin of left coronary artery from pulmonary artery (ALCAPA) after coronary artery reimplantation. We have compared the results of MRI coronary angiography, and Dobutamine stress cMRI with traditional tests. All these diagnostic exams were acquired in a timeframe of 3 month, in a blinded fashion. All the 13 patients (age: 12 ± 2 years, median 12,7 y) recruited, completed the study without major adverse events. The mean heart rate-pressure product was 25,120 ± 5110 bpm x mm Hg. The target heart rate of 85% of the maximal theoretical was reached by 10 (77%) patients. The comparison between cardiac MRI coronarography versus the gold standard Coronary Angiography to identify the patency of the origin and the proximal pathway of the coronary arteries shows a sensitivity of 100% (confidence interval: 2,5-100%), specificity 92% (confidence interval: 64-100%). The stress test was well tolerated for the 77% of the patients and completed by the totality of patients (Table 3). Three patients (23%) had mild symptoms: nausea, vomiting, or general discomfort. In pediatric patients with a potential or definite diagnosis of coronary artery disease, stress cMRI combines an effective assessment of proximal coronary arteries anatomy with cardiac function, myocardial perfusion, and viability in a single examination. Stress cMRI can be proposed as alternative, standalone test.
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11
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Zhou W, Sin J, Yan AT, Wang H, Lu J, Li Y, Kim P, Patel AR, Ng MY. Qualitative and Quantitative Stress Perfusion Cardiac Magnetic Resonance in Clinical Practice: A Comprehensive Review. Diagnostics (Basel) 2023; 13:524. [PMID: 36766629 PMCID: PMC9914769 DOI: 10.3390/diagnostics13030524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
Stress cardiovascular magnetic resonance (CMR) imaging is a well-validated non-invasive stress test to diagnose significant coronary artery disease (CAD), with higher diagnostic accuracy than other common functional imaging modalities. One-stop assessment of myocardial ischemia, cardiac function, and myocardial viability qualitatively and quantitatively has been proven to be a cost-effective method in clinical practice for CAD evaluation. Beyond diagnosis, stress CMR also provides prognostic information and guides coronary revascularisation. In addition to CAD, there is a large body of literature demonstrating CMR's diagnostic performance and prognostic value in other common cardiovascular diseases (CVDs), especially coronary microvascular dysfunction (CMD). This review focuses on the clinical applications of stress CMR, including stress CMR scanning methods, practical interpretation of stress CMR images, and clinical utility of stress CMR in a setting of CVDs with possible myocardial ischemia.
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Affiliation(s)
- Wenli Zhou
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600, Yishan Road, Shanghai 200233, China
| | - Jason Sin
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong SAR, China
| | - Andrew T. Yan
- St. Michael’s Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada
| | | | - Jing Lu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600, Yishan Road, Shanghai 200233, China
| | - Yuehua Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600, Yishan Road, Shanghai 200233, China
| | - Paul Kim
- Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
| | - Amit R. Patel
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Ming-Yen Ng
- Department of Medical Imaging, HKU-Shenzhen Hospital, Shenzhen 518009, China
- Department of Diagnostic Radiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
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12
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Qasim A, Doan TT, Dan Pham T, Reaves-O'Neal D, Sachdeva S, Mery CM, Binsalamah Z, Molossi S. Is Exercise Stress Testing Useful for Risk Stratification in Anomalous Aortic Origin of a Coronary Artery? Semin Thorac Cardiovasc Surg 2022; 35:759-768. [PMID: 36041683 DOI: 10.1053/j.semtcvs.2022.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022]
Abstract
Data on maximal exercise-stress-testing (m-EST) in anomalous-aortic-origin-of-coronary-arteries (AAOCA) is limited and correlation with stress perfusion imaging has not been demonstrated. AAOCA patients ≤20 years were prospectively enrolled from 6/2014-01/2020. A m-EST was defined as heart rate >85%ile on ECG-EST and respiratory-exchange-ratio ≥1.05 on cardiopulmonary-exercise-testing (CPET). Abnormal m-EST included significant ST-changes or high-grade arrhythmia, V̇O2max and/or O2 pulse <85% predicted, or abnormal O2 pulse curve. A (+) dobutamine-stress cardiac-magnetic-resonance-imaging (+DS-CMR) had findings of inducible-ischemia. Outcomes: (1) Differences in m-EST based on AAOCA-type; (2) Assuming DS-CMR as gold-standard for detection of inducible ischemia, determine agreement between m-EST and DS-CMR. A total of 155 AAOCA (right, AAORCA = 126; left, AAOLCA = 29) patients with a median (IQR) age of 13 (11-15) years were included; 63% were males and a m-EST was completed in 138 (89%). AAORCA and AAOLCA had similar demographic and m-EST characteristics, although AAOLCA had more frequently evidence of inducible ischemia on m-EST (P = 0.006) and DS-CMR (P = 0.007). Abnormal O2 pulse was significantly associated with +DS-CMR (OR 5.3, 95% CI 1.6-18,P = 0.005). Sensitivity was increased with addition of CPET to ECG-EST (to 58% from 19%). There was no agreement between m-EST and DS-CMR for detection of inducible ischemia. A m-EST has very low sensitivity for detection of inducible ischemia in AAOCA, and sensitivity is increased with addition of CPET. Stress perfusion abnormalities on DS-CMR were notconcordant with m-EST findings and adjunctive testing should be considered for clinical decision making in AAOCA.
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Affiliation(s)
- Amna Qasim
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; The Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas.
| | - Tam T Doan
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; The Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas.
| | - Tam Dan Pham
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
| | - Dana Reaves-O'Neal
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; The Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas.
| | - Shagun Sachdeva
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; The Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas.
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School, Dell Children's Medical Center, The University of Texas at Austin, Austin, Texas.
| | - Ziyad Binsalamah
- The Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas; Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
| | - Silvana Molossi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; The Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas.
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13
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Doan TT, Molossi S, Sachdeva S, Wilkinson JC, Loar RW, Weigand JD, Schlingmann TR, Reaves-O'Neal DL, Pednekar AS, Masand P, Noel CV. Dobutamine stress cardiac MRI is safe and feasible in pediatric patients with anomalous aortic origin of a coronary artery (AAOCA). Int J Cardiol 2021; 334:42-48. [PMID: 33892043 DOI: 10.1016/j.ijcard.2021.04.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Risk stratification in anomalous aortic origin of a coronary artery (AAOCA) is challenged by the lack of a reliable method to detect myocardial ischemia. We prospectively studied the safety and feasibility of Dobutamine stress-cardiac magnetic resonance (DSCMR), a test with excellent performance in adults, in pediatric patients with AAOCA. METHODS Consecutive DSCMR from 06/2014-12/2019 in patients≤20 years old with AAOCA were included. Hemodynamic response and major/minor events were recorded. Image quality and spatial/temporal resolution were evaluated. Rest and stress first-pass perfusion and wall motion abnormalities (WMA) were assessed. Inter-observer agreement was assessed using kappa coefficient. RESULTS A total of 224 DSCMR were performed in 182 patients with AAOCA at a median age of 14 years (IQR 12, 16) and median weight of 58.0 kg (IQR 43.3, 73.0). Examinations were completed in 221/224 (98.9%), all studies were diagnostic. Heart rate and blood pressure increased significantly from baseline (p < 0.001). No patient had major events and 28 (12.5%) had minor events. Inducible hypoperfusion was noted in 31/221 (14%), associated with WMA in 13/31 (42%). Inter-observer agreement for inducible hypoperfusion was very good (Κ = 0.87). Asymptomatic patients with inducible hypoperfusion are considered high-risk and those with a negative test are of standard risk. CONCLUSIONS DSCMR is feasible in pediatric patients with AAOCA to assess for inducible hypoperfusion and WMA. It can be performed safely with low incidence of major/minor events. Thus, DSCMR is potentially a valuable test for detection of myocardial ischemia and helpful in the management of this patient population.
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Affiliation(s)
- Tam T Doan
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA.
| | - Silvana Molossi
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA.
| | - Shagun Sachdeva
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
| | - James C Wilkinson
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
| | - Robert W Loar
- Pediatric Cardiology, Cook Children's Medical Center, 1500 Cooper St, Fort Worth, TX 76104, USA
| | - Justin D Weigand
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
| | - Tobias R Schlingmann
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
| | - Dana L Reaves-O'Neal
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
| | - Amol S Pednekar
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA
| | - Prakash Masand
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; EB Singleton Department of Pediatric Radiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
| | - Cory V Noel
- Pediatric Cardiology of Alaska, Seattle Children's Hospital, 3841 Piper St, Suite T345, Anchorage, AK 99508, USA
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14
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Bigler MR, Ashraf A, Seiler C, Praz F, Ueki Y, Windecker S, Kadner A, Räber L, Gräni C. Hemodynamic Relevance of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva-In Search of the Evidence. Front Cardiovasc Med 2021; 7:591326. [PMID: 33553251 PMCID: PMC7859106 DOI: 10.3389/fcvm.2020.591326] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/23/2020] [Indexed: 12/16/2022] Open
Abstract
Coronary artery anomalies (CAA) represent a heterogeneous group of congenital disorders of the arterial coronary circulation, defined by an anomalous origin of the coronary ostium and/or vessel course. Of particular interest are anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS). The interarterial variants (with the anomalous vessel situated between the great arteries) are historically called "malignant," based on an anticipated higher risk for myocardial ischemia and sudden cardiac death (SCD), especially affecting young patients during strenuous physical activity. However, the interarterial course itself may not be the predominant cause of ischemia, but rather represents a surrogate for other ischemia-associated anatomical high-risk features. As the exact pathophysiology of ACAOS is not well-understood, there is a lack of evidence-based guidelines addressing optimal diagnostic work-up, downstream testing, sports counseling, and therapeutic options in patients with ACAOS. Therefore, treating physicians are often left with uncertainty regarding the clinical management of affected patients. This review focuses on the pathophysiologic consequences of ACAOS on myocardial ischemia and discusses the concept of the interplay between fixed and dynamic coronary stenosis. Further, we discuss the advantages and limitations of the different diagnostic modalities and give an outlook by highlighting the gaps of knowledge in the assessment of such anomalies.
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Affiliation(s)
- Marius Reto Bigler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Afreed Ashraf
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yasushi Ueki
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Kadner
- Department of Cardiovascular Surgery, Centre for Congenital Heart Disease, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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15
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Frommelt P, Lopez L, Dimas VV, Eidem B, Han BK, Ko HH, Lorber R, Nii M, Printz B, Srivastava S, Valente AM, Cohen MS. Recommendations for Multimodality Assessment of Congenital Coronary Anomalies: A Guide from the American Society of Echocardiography: Developed in Collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2020; 33:259-294. [PMID: 32143778 DOI: 10.1016/j.echo.2019.10.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Peter Frommelt
- Children's Hospital of Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Leo Lopez
- Stanford University, Palo Alto, California
| | | | | | - B Kelly Han
- Children's Minnesota and the Minneapolis Heart Institute, Minneapolis, Minnesota
| | - H Helen Ko
- Kravis Children's Hospital, Mount Sinai Medical Center, New York, New York
| | - Richard Lorber
- Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, Texas
| | - Masaki Nii
- Shizuoka Children's Hospital, Shizuoka, Shizuoka, Japan
| | - Beth Printz
- University of California San Diego and Rady Children's Hospital, San Diego, California
| | | | - Anne Marie Valente
- Boston Children's Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meryl S Cohen
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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16
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Fares M, Critser PJ, Arruda MJ, Wilhelm CM, Rattan MS, Lang SM, Alsaied T. Pharmacologic stress cardiovascular magnetic resonance in the pediatric population: A review of the literature, proposed protocol, and two examples in patients with Kawasaki disease. CONGENIT HEART DIS 2019; 14:1166-1175. [PMID: 31498562 DOI: 10.1111/chd.12840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/13/2019] [Accepted: 08/29/2019] [Indexed: 12/01/2022]
Abstract
Pharmacologic stress cardiovascular magnetic resonance (PSCMR) is a well-established and reliable diagnostic tool for evaluation of coronary artery disease in the adult population. Stress imaging overall and PSCMR in particular is less utilized in the pediatric population with limited reported data. In this review, we highlight the potential use of PSCMR in specific pediatric cohorts with congenital and acquired heart disease, and we review the reported experience. A suggested protocol is presented in addition to two case examples of patients with Kawasaki disease where PSCMR aided decision making.
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Affiliation(s)
- Munes Fares
- Division of Pediatric Cardiology, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Paul J Critser
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maria J Arruda
- Division of Pediatric Cardiology, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Carolyn M Wilhelm
- Division of Pediatric Cardiology, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Mantosh S Rattan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sean M Lang
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Faculty of Medicine, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Tarek Alsaied
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Faculty of Medicine, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
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17
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Noel C. Cardiac stress MRI evaluation of anomalous aortic origin of a coronary artery. CONGENIT HEART DIS 2017; 12:627-629. [DOI: 10.1111/chd.12501] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Cory Noel
- Coronary Anomalies Program, Division of Pediatric Cardiology; Texas Children's Hospital; Houston Texas, USA
- Department of Pediatrics; Baylor College of Medicine; Houston Texas, USA
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18
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Noel CV, Krishnamurthy R, Moffett B, Krishnamurthy R. Myocardial stress perfusion magnetic resonance: initial experience in a pediatric and young adult population using regadenoson. Pediatr Radiol 2017; 47:280-289. [PMID: 28035425 DOI: 10.1007/s00247-016-3762-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/19/2016] [Accepted: 12/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dipyridamole and adenosine are traditional pharmacological stressors for myocardial perfusion. Regadenoson, a selective adenosine A2A agonist, has a lower side effect profile with lower incidence of bronchospasm and bradycardia. There is a growing need for myocardial perfusion assessment within pediatrics. There is no report on the utility of regadenoson as a stress agent in children. OBJECTIVE To observe the safety and feasibility of regadenoson as a pharmacologic stressor for perfusion cardiac MR in a pilot cohort of pediatric patients weighing more than 40 kg who have congenital heart disease and pediatric acquired heart disease. MATERIALS AND METHODS We reviewed our initial experience with regadenoson stress cardiac MR in 31 pediatric patients 15.8 ± 1.7 years (range 12-22 years) with congenital heart disease and acquired heart disease. Mean patient weight was 60 ± 15 kg (range of 40-93 kg). All patients underwent cardiac MR because of concern for ischemia. The cohort included a heterogeneous group of patients at a pediatric institution with potential risk for ischemia. Subjects' heart rate and blood pressure were monitored and pharmacologic stress was induced by injection of 400 mcg of regadenoson. We evaluated their hemodynamic response and adverse effects using changes in vital signs and onset of symptoms. A pediatric cardiologist and radiologist qualitatively assessed myocardial perfusion and viability images. RESULTS One child was unable to complete the stress perfusion portion of the examination, but did complete the remaining portion of the CMR. Resting heart rate was 72 ± 14 beats per minute (bpm) and rose to peak of 124 ± 17 bpm (95 ± 50% increase, P < 0.005) with regadenoson. Image quality was considered good or diagnostic in all cases. Three patients had irreversible perfusion defects. Four patients had reversible perfusion defects. Nine of the patients underwent cardiac catheterization with angiography and the findings showed excellent agreement. CONCLUSION Regadenoson might be a safe and feasible pharmacologic stress agent for use in cardiac MR in older pediatric patients with congenital heart disease and acquired heart disease. The ease of use as a bolus and the advantage of a prolonged hyperemia make its use appealing in pediatrics. In a limited number of cases, regadenoson stress perfusion showed excellent agreement with cardiac catheterization. Regadenoson might be a viable pharmacologic stress agent in this population.
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Affiliation(s)
- Cory V Noel
- Department of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA. .,Department of Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin St., MC 19345-C, Houston, TX, 77030, USA.
| | | | - Brady Moffett
- Department of Pharmacology, Texas Children's Hospital, Houston, TX, USA
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19
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Wong J, Pushparajah K, de Vecchi A, Ruijsink B, Greil GF, Hussain T, Razavi R. Pressure-volume loop-derived cardiac indices during dobutamine stress: a step towards understanding limitations in cardiac output in children with hypoplastic left heart syndrome. Int J Cardiol 2016; 230:439-446. [PMID: 28043677 PMCID: PMC5267632 DOI: 10.1016/j.ijcard.2016.12.087] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/21/2016] [Accepted: 12/16/2016] [Indexed: 11/29/2022]
Abstract
Background Children with a single systemic right ventricle, such as in hypoplastic left heart syndrome (HLHS), frequently experience reduced exercise capacity. Elucidating the causes could help with optimising treatment strategies. Methods Prospective data from 10 consecutive symptomatic patients with HLHS undergoing clinical cardiac magnetic resonance with catheterisation (XMR) were analysed. Mean age 8.6 years (range 3.5–11.6 years), mean time since Fontan completion 5.5 years. MR-compatible catheters were placed in the systemic right ventricle and branch pulmonary arteries to record pressures at rest, with dobutamine infusion at 10 mcg/kg/min and at 20 mcg/kg/min. Cine short-axis stacks of the ventricle were performed at each condition and used to construct pressure–volume loops. Results Compared to rest, cardiac index increased with low-dose dobutamine (p < 0.01) with no further rise at peak stress despite a further, albeit, blunted rise in heart rate (p = 0.002). A fall in stroke volume occurred (p = 0.014) despite good contractility (74% increase, p = 0.045) and a well-coupled ventriculo-arterial ratio. End-diastolic pressure and early active relaxation, markers of diastolic function, were normal at rest. However, preload fell at peak stress (p < 0.008) while pulmonary vascular resistance (PVR) was low throughout. This group of HLHS patients demonstrated a fall in SV at peak stress, coinciding with a fall in preload. Conclusions Markers of systolic and diastolic function remained normal. Failure to adequately fill the ventricle implies a ceiling of maximal flow through the Fontan circuit despite low PVR.
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Affiliation(s)
- James Wong
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Kuberan Pushparajah
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Adelaide de Vecchi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Bram Ruijsink
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Gerald F Greil
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, United Kingdom.
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20
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Abstract
Myocardial fibrosis is common in patients with congenital heart disease (CHD) and has been associated with arrhythmias, decreased functional status, and adverse ventricular mechanics. There are multiple types of myocardial fibrosis that occur in response to different pathophysiologic stimuli. Recent advances in imaging technology have made detection and quantification of the types of myocardial fibrosis possible. In this review, we describe the pathophysiology of myocardial fibrosis, examine the imaging techniques used to evaluate fibrosis, and discuss the relationship between myocardial fibrosis and clinical outcomes in CHD. (Circ J 2016; 80: 1300-1307).
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Affiliation(s)
- Rahul H Rathod
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School
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21
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Brissaud O, Botte A, Cambonie G, Dauger S, de Saint Blanquat L, Durand P, Gournay V, Guillet E, Laux D, Leclerc F, Mauriat P, Boulain T, Kuteifan K. Experts' recommendations for the management of cardiogenic shock in children. Ann Intensive Care 2016; 6:14. [PMID: 26879087 PMCID: PMC4754230 DOI: 10.1186/s13613-016-0111-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/26/2016] [Indexed: 12/13/2022] Open
Abstract
Cardiogenic shock which corresponds to an acute state of circulatory failure due to impairment of myocardial contractility is a very rare disease in children, even more than in adults. To date, no international recommendations regarding its management in critically ill children are available. An experts’ recommendations in adult population have recently been made (Levy et al. Ann Intensive Care 5(1):52, 2015; Levy et al. Ann Intensive Care 5(1):26, 2015). We present herein recommendations for the management of cardiogenic shock in children, developed with the grading of recommendations’ assessment, development, and evaluation system by an expert group of the Groupe Francophone de Réanimation et Urgences Pédiatriques (French Group for Pediatric Intensive Care and Emergencies). The recommendations cover four major fields of application such as: recognition of early signs of shock and the patient pathway, management principles and therapeutic goals, monitoring hemodynamic and biological variables, and circulatory support (indications, techniques, organization, and transfer criteria). Major principle care for children with cardiogenic shock is primarily based on clinical and echocardiographic assessment. There are few drugs reported as effective in childhood in the medical literature. The use of circulatory support should be facilitated in terms of organization and reflected in the centers that support these children. Children with cardiogenic shock are vulnerable and should be followed regularly by intensivist cardiologists and pediatricians. The experts emphasize the multidisciplinary nature of management of children with cardiogenic shock and the importance of effective communication between emergency medical assistance teams (SAMU), mobile pediatric emergency units (SMUR), pediatric emergency departments, pediatric cardiology and cardiac surgery departments, and pediatric intensive care units.
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Affiliation(s)
- Olivier Brissaud
- Unité de Réanimation Pédiatrique et Néonatale, Hôpital des Enfants, CHU Pellegrin Enfants, Place Amélie Raba Léon, 33000, Bordeaux, France.
| | - Astrid Botte
- Unité de Réanimation Pédiatrique, Faculté de Médecine, Université de Lille Nord de France, Hôpital Jeanne de Flandre CHU de Lille, 54, Avenue Eugène Avinée, 59037, Lille Cedex, France
| | - Gilles Cambonie
- Département de Pédiatrie Néonatale et Réanimations, Pôle Hospitalo-Universitaire Femme-Mère-Enfant, Hôpital Arnaud-de-Villeneuve, Centre Hospitalier Régional Universitaire de Montpellier, 371, Avenue du Doyen-Gaston-Giraud, 34295, Montpellier Cedex 5, France
| | - Stéphane Dauger
- Réanimation et Surveillance Continue Pédiatriques, Pôle de Pédiatrie Médicale, Hôpital Robert-Debré, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, 48, Boulevard Sérurier, 75019, Paris, France
| | - Laure de Saint Blanquat
- Service de Réanimation, CHU Necker-Enfants-Malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France
| | - Philippe Durand
- Réanimation Pédiatrique, AP-HP, CHU Kremlin Bicêtre, 78, rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France
| | - Véronique Gournay
- Service de Cardiologie Pédiatrique, CHU de Nantes, 44093, Nantes Cedex, France
| | - Elodie Guillet
- Unité de Réanimation Pédiatrique et Néonatale, Hôpital des Enfants, CHU Pellegrin Enfants, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Daniela Laux
- Pôle des Cardiopathies Congénitales, Centre Chirurgical Marie Lannelongue, 133, Avenue de la Résistance, 92350, Le Plessis-Robinson, France
| | - Francis Leclerc
- Unité de Réanimation Pédiatrique, Faculté de Médecine, Université de Lille Nord de France, Hôpital Jeanne de Flandre CHU de Lille, 54, Avenue Eugène Avinée, 59037, Lille Cedex, France
| | - Philippe Mauriat
- Service de Cardiologie Pédiatrique et Congénitale, Hôpital Haut-Lévèque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac Cedex, France
| | - Thierry Boulain
- Service de Réanimation Polyvalente, Hôpital de La Source, Centre Hospitalier Régional Orléans, 45067, Orléans, France
| | - Khaldoun Kuteifan
- Service de Réanimation Médicale, Hôpital Émile-Muller, 68070, Mulhouse, France
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22
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Mitchell FM, Prasad SK, Greil GF, Drivas P, Vassiliou VS, Raphael CE. Cardiovascular magnetic resonance: Diagnostic utility and specific considerations in the pediatric population. World J Clin Pediatr 2016; 5:1-15. [PMID: 26862497 PMCID: PMC4737683 DOI: 10.5409/wjcp.v5.i1.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/10/2015] [Accepted: 12/15/2015] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular magnetic resonance is a non-invasive imaging modality which is emerging as important tool for the investigation and management of pediatric cardiovascular disease. In this review we describe the key technical and practical differences between scanning children and adults, and highlight some important considerations that must be taken into account for this patient population. Using case examples commonly seen in clinical practice, we discuss the important clinical applications of cardiovascular magnetic resonance, and briefly highlight key future developments in this field.
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23
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Partington SL, Valente AM, Landzberg M, Grant F, Di Carli MF, Dorbala S. Clinical applications of radionuclide imaging in the evaluation and management of patients with congenital heart disease. J Nucl Cardiol 2016; 23:45-63. [PMID: 26129940 DOI: 10.1007/s12350-015-0185-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 05/12/2015] [Indexed: 02/04/2023]
Abstract
Non-invasive testing of children with congenital heart disease (CHD) began in the 1950s with the introduction of radionuclide studies to assess shunt fractions, pulmonary blood flow, and ventricular contractile function. Echocardiography and cardiac magnetic resonance imaging have since replaced radionuclide imaging in many of these roles. Concurrently, percutaneous and surgical repairs of complex CHD evolved, creating new roles for radionuclide imaging. In this paper on applications of radionuclide imaging in CHD, we review the multiple mechanisms for myocardial ischemia in CHD. We critically compare optimal radionuclide imaging techniques to other imaging modalities for assessing ischemia in CHD. We present the current role of nuclear imaging for assessing viability and pulmonary blood flow. We highlight the value added by advances in dedicated cardiac SPECT scanners, novel reconstruction software, and cardiac PET in performing low-dose radionuclide imaging in CHD. Finally, we discuss the emerging clinical indications for radionuclide imaging in CHD including coronary flow reserve assessment and evaluation of cardiovascular prosthesis and device infections.
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Affiliation(s)
- Sara L Partington
- The Philadelphia Adult Congenital Heart Disease Program. A Joint Program of Penn Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Anne Marie Valente
- Boston Adult Congenital Heart Disease and Pulmonary Hypertension program, A Joint Program of Brigham and Women's Hospital and the Boston Children's Hospital, Boston, MA, USA
| | - Michael Landzberg
- Boston Adult Congenital Heart Disease and Pulmonary Hypertension program, A Joint Program of Brigham and Women's Hospital and the Boston Children's Hospital, Boston, MA, USA
| | - Frederick Grant
- Division of Nuclear Medicine, Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Marcelo F Di Carli
- Noninvasive Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiology), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, 70 Francis Street, Shapiro 5th Floor, Room 128, Boston, MA, 02115, USA
| | - Sharmila Dorbala
- Noninvasive Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiology), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, 70 Francis Street, Shapiro 5th Floor, Room 128, Boston, MA, 02115, USA.
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Pushparajah K, Wong JK, Bellsham-Revell HR, Hussain T, Valverde I, Bell A, Tzifa A, Greil G, Simpson JM, Kutty S, Razavi R. Magnetic resonance imaging catheter stress haemodynamics post-Fontan in hypoplastic left heart syndrome. Eur Heart J Cardiovasc Imaging 2015; 17:644-51. [PMID: 26188193 DOI: 10.1093/ehjci/jev178] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 06/18/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Exercise limitation is common post-Fontan. Hybrid X-ray and magnetic resonance imaging (XMR) catheterization allows haemodynamic assessment by means of measurement of ventricular volumes and flow in major vessels with simultaneous invasive pressures. We aim to assess haemodynamic response to stress in patients with hypoplastic left heart syndrome (HLHS) post-Fontan. METHODS AND RESULTS Prospective study of 13 symptomatic children (NHYA 2) with HLHS post-Fontan using XMR catheterization. Three conditions were applied: baseline (Stage 1), dobutamine at 10 µg/kg/min (Stage 2), and dobutamine at 20 µg/kg/min (Stage 3). Seven consecutive patients received inhaled nitric oxide (iNO) at peak stress. Control MRI data were from normal healthy adults. In the HLHS patients, baseline mean pulmonary vascular resistance (PVR) was 1.51 ± 0.59 WU m(2) and aortopulmonary collateral flow was 17.7 ± 13.6% of systemic cardiac output. Mean right ventricular end-diastolic pressure was 6.7 ± 2.5 mmHg which did not rise with stress. Cardiac index (CI) increased at Stage 2 in HLHS (40%) and controls (61%) but continued to increase at Stage 3 only in controls (19%) but not in HLHS. The blunted rise in CI in HLHS was due to a continuing fall in end-diastolic volume throughout stress, with no significant change in PVR or CI at peak stress in response to iNO. CONCLUSION Cardiac output post-Fontan in HLHS at peak stress is blunted due to a limitation in preload which is not responsive to inhaled pulmonary vasodilators in the setting of normal PVR.
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Affiliation(s)
- Kuberan Pushparajah
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James K Wong
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Hannah R Bellsham-Revell
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tarique Hussain
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Israel Valverde
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Aaron Bell
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Aphrodite Tzifa
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gerald Greil
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John M Simpson
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Shelby Kutty
- University of Nebraska/Creighton University Joint Division of Pediatric Cardiology, Omaha, NE, USA
| | - Reza Razavi
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Paediatric Cardiovascular Sciences, Rayne Institute, King's College London and Evelina London Children's Hospital, Westminster Bridge Road, London SE1 7EH, UK
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25
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Pushparajah K, Tzifa A, Razavi R. Cardiac MRI catheterization: a 10-year single institution experience and review. Interv Cardiol 2014. [DOI: 10.2217/ica.14.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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26
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Ntsinjana HN, Tann O, Taylor AM. Trends in pediatric cardiovascular magnetic resonance imaging. Acta Radiol 2013; 54:1063-74. [PMID: 23390156 DOI: 10.1177/0284185113475609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiac magnetic resonance (CMR) imaging has significantly evolved over the last decade, becoming an integral part of the contemporary assessment of both congenital and acquired pediatric heart disease. Recent trends show that there is a growing interest in clinical applications and research in this field. An attempt to discuss the evolving technologies, techniques, and applications of CMR in pediatrics is not complete without understanding the current strengths of the modality. CMR complements readily available echocardiography, in many cases information from CMR can remove the need for invasive angiographic catheterization, and in other cases can be used to augment cardiac catheterisation.
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Affiliation(s)
- Hopewell N Ntsinjana
- Centre for Cardiovascular Imaging, UCL
Institute of Cardiovascular Sciences, London
- Cardiorespiratory Unit, Great Ormond
Street Hospital for Children, London, UK
| | - Oliver Tann
- Centre for Cardiovascular Imaging, UCL
Institute of Cardiovascular Sciences, London
- Cardiorespiratory Unit, Great Ormond
Street Hospital for Children, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL
Institute of Cardiovascular Sciences, London
- Cardiorespiratory Unit, Great Ormond
Street Hospital for Children, London, UK
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27
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Fratz S, Chung T, Greil GF, Samyn MM, Taylor AM, Valsangiacomo Buechel ER, Yoo SJ, Powell AJ. Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease. J Cardiovasc Magn Reson 2013; 15:51. [PMID: 23763839 PMCID: PMC3686659 DOI: 10.1186/1532-429x-15-51] [Citation(s) in RCA: 331] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/08/2013] [Indexed: 01/12/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) has taken on an increasingly important role in the diagnostic evaluation and pre-procedural planning for patients with congenital heart disease. This article provides guidelines for the performance of CMR in children and adults with congenital heart disease. The first portion addresses preparation for the examination and safety issues, the second describes the primary techniques used in an examination, and the third provides disease-specific protocols. Variations in practice are highlighted and expert consensus recommendations are provided. Indications and appropriate use criteria for CMR examination are not specifically addressed.
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Affiliation(s)
- Sohrab Fratz
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (German Heart Center Munich) of the Technical University Munich, Munich, Germany
| | - Taylor Chung
- Department of Diagnostic Imaging, Children’s Hospital & Research Center Oakland, Oakland, California, USA
| | - Gerald F Greil
- Department of Pediatric Cardiology, Evelina Children’s Hospital/Guy’s and St. Thomas’ Hospital NHS Foundation Trust; Division of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
| | - Margaret M Samyn
- The Herma Heart Center, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, & Great Ormond Street Hospital for Children, London, UK
| | | | - Shi-Joon Yoo
- Department of Diagnostic Imaging and Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Andrew J Powell
- Department of Cardiology, Boston Children’s Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Ou P, Kutty S, Khraiche D, Sidi D, Bonnet D. Acquired coronary disease in children: the role of multimodality imaging. Pediatr Radiol 2013; 43:444-53. [PMID: 22972555 DOI: 10.1007/s00247-012-2478-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 06/01/2012] [Accepted: 07/18/2012] [Indexed: 10/27/2022]
Abstract
Coronary sequelae of Kawasaki disease, post-surgical coronary lesions and cardiac allograft vasculopathy are the main causes of acquired coronary pathology in childhood. Surveillance and timely recognition of coronary problems in children who are at risk of ischemic events are imperative and noninvasive imaging is increasingly utilized for these purposes. Herein, we summarize the causes of acquired coronary disease in children and discuss the role of various imaging techniques that are available to establish the diagnosis and guide management.
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Affiliation(s)
- Phalla Ou
- Service de Radiologie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, University Paris-Descartes, 149 rue de Sèvres, 75743, Paris Cedex 15, France.
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Ntsinjana HN, Hughes ML, Taylor AM. The role of cardiovascular magnetic resonance in pediatric congenital heart disease. J Cardiovasc Magn Reson 2011; 13:51. [PMID: 21936913 PMCID: PMC3210092 DOI: 10.1186/1532-429x-13-51] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 09/21/2011] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has expanded its role in the diagnosis and management of congenital heart disease (CHD) and acquired heart disease in pediatric patients. Ongoing technological advancements in both data acquisition and data presentation have enabled CMR to be integrated into clinical practice with increasing understanding of the advantages and limitations of the technique by pediatric cardiologists and congenital heart surgeons. Importantly, the combination of exquisite 3D anatomy with physiological data enables CMR to provide a unique perspective for the management of many patients with CHD. Imaging small children with CHD is challenging, and in this article we will review the technical adjustments, imaging protocols and application of CMR in the pediatric population.
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Affiliation(s)
- Hopewell N Ntsinjana
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Marina L Hughes
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
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Valverde I, Parish V, Tzifa A, Head C, Sarikouch S, Greil G, Schaeffter T, Razavi R, Beerbaum P. Cardiovascular MR dobutamine stress in adult tetralogy of fallot: Disparity between CMR volumetry and flow for cardiovascular function. J Magn Reson Imaging 2011; 33:1341-50. [DOI: 10.1002/jmri.22573] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
PURPOSE OF REVIEW Heart failure is an important problem after surgical correction of congenital heart disease. Timely recognition may be difficult. Recent developments in exercise testing and stress-imaging may change the management of patients with congenital heart disease. RECENT FINDINGS Exercise tests are commonly used in the follow-up of patients with congenital heart disease. Maximal exercise studies are not always feasible in this patient population. Variables of submaximal exercise and ventilator efficiency have shown a good correlation with variables of maximal exercise and have been suggested to relate to long-term cardiac function.For evaluation of submaximal exercise, stress imaging may reveal abnormal responses unrecognized at rest. Both physical exercise as well as pharmacological stress may be used in combination with various imaging modalities. For practical reasons, dobutamine is most widely used to generate and mimic stress and is well tolerated in low doses. Particularly in lesions affecting the right ventricle and with single ventricular physiology after the Fontan operation, magnetic resonance stress imaging has provided additional insight into the cardiac function. SUMMARY The abnormal stress responses can potentially be used for risk assessment in the follow-up of patients with congenital cardiac disease. Further studies are required to provide common protocols for stress imaging.
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Hughes ML, Muthurangu V, Taylor AM. Cardiovascular MR imaging — Indications, techniques and protocols. PROGRESS IN PEDIATRIC CARDIOLOGY 2010. [DOI: 10.1016/j.ppedcard.2009.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
In patients with coronary arterial disease, stress imaging is able to demonstrate abnormalities in the motion of the ventricular walls, and abnormalities in coronary arterial perfusion not apparent at rest. It can also provide information on prognostic factors. In patients with congenitally malformed hearts, stress imaging is used to determine contractile reserve, abnormalities of mural motion, and global systolic function, but also to assess diastolic and vascular function. In most of these patients, stress is usually induced using pharmacological agents, mainly dobutamine given in varying doses. The clinical usefulness of abnormal responses to the stress induced in such patients has to be addressed in follow-up studies. The abnormal stress might serve as surrogate endpoints, predicting primary endpoints at an early stage, which are useful for stratification of risk in this population of growing patients. We review here the stress imaging studies performed to date in patients with congenitally malformed hearts, with a special emphasis on echocardiography and cardiac magnetic resonance imaging.
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Robbers-Visser D, Luijnenburg SE, van den Berg J, Roos-Hesselink JW, Strengers JL, Kapusta L, Moelker A, Helbing WA. Safety and observer variability of cardiac magnetic resonance imaging combined with low-dose dobutamine stress-testing in patients with complex congenital heart disease. Int J Cardiol 2009; 147:214-8. [PMID: 19740557 DOI: 10.1016/j.ijcard.2009.08.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 08/08/2009] [Accepted: 08/16/2009] [Indexed: 01/02/2023]
Abstract
BACKGROUND In patients with complex congenital heart disease (CHD) abnormal ventricular stress responses have been reported with dobutamine stress cardiovascular magnetic resonance (DCMR). These abnormal stress responses are potential indicators of long-term outcome. However, safety and reproducibility of this technique has not been reported in a larger study. The aim of this study was to report our experiences regarding safety and intra-observer and inter-observer variability of low-dose DCMR in complex CHD. METHODS In 91 patients, 110 low-dose DCMR studies were performed with acquisition of a short axis set at rest, and during dobutamine administration (7.5 μg/kg/min maximum). We assessed biventricular end-diastolic volumes, end-systolic volumes, stroke volumes, ejection fraction and ventricular mass. Intra- and inter-observer variability for all variables was assessed by calculating the coefficient of variation (%), i.e. the standard deviation of the difference divided by the mean of 2 measurements multiplied by 100%. RESULTS In 3 patients minor side effects occurred (vertigo, headache, and bigeminy). Ten patients experienced an increase in heart rate of >150% from baseline, although well tolerated. For all variables, intra-observer variability was <10% at rest and during stress. At rest, inter-observer variability was 10.5% maximal. With stress-testing, only the variability of biventricular end-systolic volumes (ESV) exceeded 10%. CONCLUSIONS In patients with complex CHD low-dose DCMR is feasible, and safe. Intra-observer variability is low for rest and stress measurements. Inter-observer variability of biventricular ESV is high with stress-testing. Whether this limits the potential usefulness of DCMR for risk assessment during follow-up has to be assessed.
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Affiliation(s)
- Daniëlle Robbers-Visser
- Department of Paediatrics, Division of Cardiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
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