Fratz Sohrab, Hess John, Schuhbaeck Annika, Buchner Christine, Hendrich Eva, Martinoff Stefan, Stern Heiko
Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany.
J Cardiovasc Magn Reson. 2008 Oct 17;10(1):46. doi: 10.1186/1532-429X-10-46.
Cardiovascular magnetic resonance (CMR) of patients with congenital heart disease (CHD) has become routine clinical practice. However, existing CMR protocols focus predominantly on patients with ischemic heart disease, and information is limited on the types of patient with CHD who benefit from CMR investigation, and in what ways. Therefore the aim of this study was to answer the questions: What type of patients were studied by CMR in a centre specializing in paediatric and adult CHD management? What questions were asked, which protocols were used and were the questions successfully answered? To answer these questions, we conducted a cohort study of all 362 patients that received routine clinical CMR during 2007 at the Department of Paediatric Cardiology and Congenital Heart Disease at the Deutsches Herzzentrum München.
Underlying diagnosis was in 33% Fallot's tetralogy, 17% aortic coarctation, 8% Ebstein's disease, 6% Marfan's disease, 4% single ventricle with Fontan-like circulation, and 32% others. Median age was 26 years (7 days - 75 years). Ventricular volumes were assessed in 67% of the patients; flow in 74%; unknown anatomy only in 9%; specific individual morphology of known anatomy in 83%; myocardial fibrosis in 8%; stress-induced myocardial perfusion defects in 1%. Only in 3% of the cases the question could not be fully answered.
Contrary to common belief, routine CMR of patients with CHD was not requested to address global anatomical questions so much as to clarify specific questions of morphology and function of known anatomy. The CMR protocols used differed markedly from those widely used in patients with ischemic heart disease.
先天性心脏病（CHD）患者的心血管磁共振成像（CMR）已成为常规临床实践。然而，现有的CMR方案主要侧重于缺血性心脏病患者，关于哪些类型的CHD患者能从CMR检查中获益以及获益方式的信息有限。因此，本研究的目的是回答以下问题：在一家专门管理小儿和成人CHD的中心，接受CMR检查的是哪些类型的患者？提出了哪些问题，使用了哪些方案，这些问题是否得到成功解答？为了回答这些问题，我们对2007年在慕尼黑德国心脏中心小儿心脏病学和先天性心脏病科接受常规临床CMR检查的所有362例患者进行了队列研究。
基础诊断为法洛四联症的占33%，主动脉缩窄的占17%，埃布斯坦畸形的占8%，马凡综合征的占6%，单心室伴类Fontan循环的占4%，其他的占32%。中位年龄为26岁（7天至75岁）。67%的患者评估了心室容积；74%的患者评估了血流；仅9%的患者解剖结构不明；83%的患者评估了已知解剖结构的特定个体形态；8%的患者评估了心肌纤维化；1%的患者评估了应激诱导的心肌灌注缺损。只有3%的病例问题未能得到充分解答。
与普遍看法相反，CHD患者的常规CMR检查并非主要用于解决整体解剖问题，而是更多地用于阐明已知解剖结构的形态和功能的特定问题。所使用的CMR方案与缺血性心脏病患者广泛使用的方案有显著差异。
