Johansson Bengt, Babu-Narayan Sonya V, Kilner Philip J, Cannell Timothy M, Mohiaddin Raad H
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK.
Cardiol Young. 2010 Feb;20(1):1-7. doi: 10.1017/S1047951109990692. Epub 2009 Nov 24.
Cardiovascular magnetic resonance assessment of adults late after an atrial redirection operation for transposition is demanding and time consuming. We hypothesised that the relatively fast and standardised 3-dimensional time-resolved contrast-enhanced magnetic resonance angiography, or dynamic angiography, would be valuable in the periodic follow-up of these patients.
We investigated prospectively 36 adults with transposition using dynamic angiography, comparing our results against a comprehensive but non-contrast cardiovascular magnetic resonance protocol. We acquired 6 dynamic angiographic datasets after injection of contrast. The primary aim was to detect significant obstruction of the pathways for venous flow.
In 4 patients (11%), we found evidence of moderate-to-severe, and thus clinically important, obstruction of systemic venous channels on standard cardiovascular magnetic resonance. All these patients were correctly identified by dynamic angiography. In 4 additional patients, we found mild and haemodynamically insignificant obstructions in the systemic venous channels. Of the 8 (22%) patients with any obstruction, 6 were detected by angiography. There were no false positives reported, giving sensitivity of 75% and specificity of 100%, a positive predictive value of 100%, and negative predictive value of 93%. In 1 patient, there was a moderate obstruction of the pulmonary venous compartment which was not readily seen by dynamic angiography.
3-dimensional dynamic angiography is a useful method for detecting anatomically moderate-to-severe, but not mild, obstructions in the systemic venous channels following Mustard repair for transposition. This technique can be used as a single imaging method and/or as complimentary to standard two dimensional cardiovascular magnetic resonance techniques for detection of clinically important obstructions in the systemic venous channels.
对接受心房调转术治疗大动脉转位的成人患者进行心血管磁共振评估要求高且耗时。我们推测，相对快速且标准化的三维时间分辨对比增强磁共振血管造影术（即动态血管造影术）在这些患者的定期随访中具有重要价值。
我们前瞻性地对36例大动脉转位的成人患者进行了动态血管造影术研究，并将结果与全面但非对比增强的心血管磁共振检查方案进行比较。注射造影剂后，我们采集了6组动态血管造影数据集。主要目的是检测静脉血流通道的明显梗阻情况。
在4例患者（11%）中，我们在标准心血管磁共振检查中发现了体静脉通道存在中度至重度梗阻的证据，因此具有临床重要性。所有这些患者均通过动态血管造影术得到正确识别。另外4例患者中，我们发现体静脉通道存在轻度且血流动力学上无显著意义的梗阻。在8例（22%）存在任何梗阻的患者中，6例通过血管造影术被检测到。未报告假阳性结果，敏感性为75%，特异性为100%，阳性预测值为100%，阴性预测值为93%。有1例患者肺静脉腔存在中度梗阻，动态血管造影术不易观察到。
三维动态血管造影术是检测Mustard修复术后大动脉转位患者体静脉通道解剖学上中度至重度而非轻度梗阻的有用方法。该技术可作为单一成像方法和/或作为标准二维心血管磁共振技术的补充，用于检测体静脉通道临床上重要的梗阻情况。
