Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI.

This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.

Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI.

This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.

[Consensus recommendations of the German Radiology Society (DRG), the German Cardiac Society (DGK) and the German Society for Pediatric Cardiology (DGPK) on the use of cardiac imaging with computed tomography and magnetic resonance imaging]. / Konsensusempfehlungen der DRG/DGK/DGPK zum Einsatz der Herzbildgebung mit Computertomografie und Magnetresonanztomografie.

Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) have been developed rapidly in the last decade. Technical improvements and broad availability of modern CT and MRI scanners have led to an increasing and regular use of both diagnostic methods in clinical routine. Therefore, this German consensus document has been developed in collaboration by the German Cardiac Society, German Radiology Society, and the German Society for Pediatric Cardiology. It is not oriented on modalities and methods, but rather on disease entities. This consensus document deals with coronary artery disease, cardiomyopathies, arrhythmias, valvular diseases, pericardial diseases and structural changes, as well as with congenital heart defects. For different clinical scenarios both imaging modalities CT and MRI are compared and evaluated in the specific context.

Myocardial scars determined by delayed-enhancement magnetic resonance imaging and positron emission tomography are not common in right ventricles with systemic function in long-term follow up.

OBJECTIVE: To test the hypothesis that myocardial scars are common in patients with systemic right ventricles. METHODS: 27 consecutive patients with systemic right ventricle were studied with delayed-enhancement magnetic resonance imaging and positron emission tomography. Of the 27 patients, 18 had had an atrial switch operation a mean of 21.8 (SD 4.5) years previously and were 23.4 (SD 5.3) years old. Nine patients without previous heart surgery had congenitally corrected transposition of the great arteries and were 35.3 (SD 15.6) years old. RESULTS: Only one patient had a subendocardial scar identified by delayed-enhancement magnetic resonance imaging. Positron emission tomography identified no myocardial scars. CONCLUSIONS: This study shows that the hypothesis that myocardial scars are common in patients with systemic right ventricles is not correct.

Pregnancy in congenital cardiac disease: an increasing challenge for cardiologists and obstetricians -- a prospective multicenter study.

OBJECTIVES: Aim of this study was to assess the occurrence of pregnancy-related complications of mother and child during pregnancy, delivery and puerperium in women with CCD prospectively. STUDY DESIGN, POPULATION: This prospective multicenter study included 122 pregnancies in 106 women with CCD (72 with, 34 without previous cardiac surgery). Patient age was 17-44, median 26 years. Cardiac and non-cardiac complications, mode of delivery, abortion, and CCD of the newborn were assessed. RESULTS: Initially all women were in Functional Class I or II. Worsening during pregnancy occurred in 25.5% (n=27), mainly during the second and third trimester. Significant problems due to bleeding, hypertension, rhythm disturbances, endocarditis, liver congestion, increasing cyanosis or death, occurred in 11.3%. Twelve per cent of deliveries were premature. Five women had therapeutic abortion, nine spontaneous abortions, nine preterm births, and one intrauterine death. Seventy-nine per cent (n=85) delivered spontaneously; 21.3% (n=23) had caesarean section. Of the 111 live born children, 5.4% (n=6) had a CCD. CONCLUSIONS: Most women with CCD and a good functional class before pregnancy tolerate pregnancy without major problems. However, pregnancy may induce serious cardiac and obstetric complications. The specific risks require an individualized multidisciplinary patient-management by experienced physicians.

Imaging in adults with congenital cardiac disease (ACCD).

Management of patients with congenital heart disease requires detailed information on cardiac and great vessel morphology. In previous years, the diagnosis and the treatment of congenital malformations has often depended on cardiac catherization, and in many institutions, cardiac catherization still remains the gold standard against which other modalities are measured. In the past decade, however, imaging methodologies have increasingly shifted toward the use of less invasive and noninvasive techniques. Currently, echocardiography is the initial method of choice in evaluating the anatomy, especially in younger patients. Meanwhile, several newer imaging techniques like magnetic resonance imaging (MRI) and spiral or multislice computed tomography (CT) are in use. They offer extremely useful information about abnormalities of the heart and great vessels as well as the assessment of cardiac anatomy and function. Echo, angiography, MRI and CT should be seen as complimentary investigations in adult congenital heart disease.

The concept of protective stent placement after successful recanalization of chronic total coronary occlusions: a matched pair analysis in 100 patients.

OBJECTIVE: Interim results of successful balloon angioplasty for total coronary occlusions (TCO) are disappointing due to the high rate of restenosis and reocclusion. Adjunctive stenting has been suggested to improve patency rate after recanalization of total coronary occlusions (TCO); however, this concept of protective stenting has not been substantiated in a case control study. METHODS: To test the efficacy of protective stenting of TCO, 100 patients were subjected to a matched pair analysis (block design) comparing conventional PTCA with protective stenting (Palmaz-Schatz stents) after successful recanalization of TCO followed by a standard antithrombotic regimen. Matching parameters included age (+/- 3.5 years), sex, cardiovascular risk factor, and lesion anatomy. Coronary angiography and QCA were performed before pair assignment, after the intervention, and at a mean follow-up of 5 +/- 1.5 months. RESULTS: There were no deaths or myocardial infarctions related to the intervention in the entire study cohort; bleeding at the puncture site was observed in two patients in both groups. Binary reocclusion and restenosis (> or = 50%) rates were observed in 8% and 0% in stented patients versus 30% and 22% in the group with no protective stenting, respectively (p < 0.01). Target lesion reintervention was necessary in 8% after protective stenting as compared to 58% after PTCA alone (p < 0.001). At 6 months follow-up, 62% of stented patients were free of any symptoms versus 23% with PTCA (p < 0.01). CONCLUSIONS: Protective stenting improves the immediate and follow-up angiographic and clinical results of PTCA in chronic total coronary occlusions. Stenting of successfully recanalized total coronary occlusions should be a routine procedure.