Congenital heart disease

a) SCMR official document standardized acquisition guidelines – relevant extract

For all diagnoses:
1. LV and RV structure and function module
a. In many cases, a contiguous stack of transaxial SSFP cine images from the inferior wall of the LV through the top of the aortic arch is recommended.
b. Gradient echo cine or hybrid gradient echo/echo planar imaging may be added for improved detection of turbulent flow in particular planes
2. Scout imaging in the plane of the ascending aorta and main pulmonary artery.
3. Through plane velocity encoded cine imaging through the main pulmonary artery and aorta to measure Qp and Qs.
4. Time resolved or multiple rapid dynamic 3D gadolinium enhanced magnetic resonance angiography in a coronal orientation For individual diagnoses, protocols must be individualized. Additional sequences to consider:

1. For shunt lesions
a. Measurement of Qp:Qs as above
b. In plane and/or through plane velocity encoded gradient echo sequence to visualize rather than measure shunt flow
2. For lesions involving the great vessels
a. SSFP cine imaging in parasagittal plane parallel to aorta
b. Specific alignment of cines with jet flow through aortic coaractation, flowed by through-plane jet velocity mapping to measure peak velocity and recognize possible diagnostic prolongation of forward flow
c. Assessment of valves as per valvular protocol
d. SSFP cine and/or gradient echo cine images along the individual pulmonary arteries
e. Comparison of RPA with LPA flow volume in the case of unilateral branch PA stenosis.

b) SCMR official document reporting recommendations – relevant extract

Morphology (descriptive)
a. Simple Lesions
b. Complex Lesions
. situs
ii. ventriculoarterial relationship
iii. atrioventricular relationship
iv. pulmonary venous connection
v. systemic veins and connections
vi. septal defects
vii. valvular lesions (including atresia)
viii. pulmonary arteries (systemic pulmonary collaterals)
ix. aorta
x. others

RV and LV Volumes with and without indexing to body surface area
PA and Aortic Dimensions (diameters)
i. MPA
ii. LPA
iii. Coarctation (minimum)
iv. Shunt or conduit (minimum and maximum)
Blood Flow, Velocity
a. Pulmonary/systemic flow ratio
b. Valve (if regurgitant) (name of valve)
i. forward flow
ii. regurgitant flow
iii. regurgitant fraction
c. Valve (if stenotic) (name of valve)
i. peak velocity (gradient)
ii. other
d. Coarctation
i. peak velocity (gradient)
ii. collateral flow estimate
e. Pulmonary arterial flow
i. MPA
ii. LPA
iii. RPA
f. Shunt or Conduit Flow (name of shunt or conduit)
i. flow
ii. peak velocity (conduit)

c) Standardized web based images

Tetralogy of Fallot case.
Case notes: Case from Dr Andrew Taylor. Great Ormond Street. This protocol has focused on the RV and pulmonary valve. There is free PR on the flow mapping (series_41 and series_47), and RVOT 3D reconstructions have been created to assess suitability for percutaneous valve implantation.

d) Case of the Week example(s)

Number 11-01: Aberrant Left Upper Pulmonary Vein with drainage into the brachiocephalic vein.
History: A 43 year old male presented with history of dyspnea on exertion and family history of sudden cardiac death. Initial workup...

Number 10-22: Anomalous Right Coronary Artery Arising from the Main Pulmonary Artery
History: Multimodality imaging of an anomalous right coronary artery arising from the pulmonary arterial trunk

Number 10-18: Aortic Coarctation Repair with associated Bicuspid Aortic Valve
History: 3D MRA demonstrating pre and post stenting of descending thoracic aorta coactation in addition to a bicuspid aortic valve with dilated aortic root.

Number 10-27: Giant Systemic Venous Collateral
History: MRI evaluation of a double outlet right ventricle with a giant systemic venous collateral

Number 10-14: Persistent Left SVC and AF Ablation
History: Electrical Activation of Atrial Fibrillation via persistent left SVC

Number 10-03: Unicuspid aortic valve and associated anomalies
History: A 24-year-old male underwent a subclavian flap repair for aortic coarctation at the age of 1. A recent echocardiogram had been reported as showing mild aortic regurgitation and a dilated aortic root.

Number 09-11: Gerbode Ventricular Septal Defect after Ross Procedure
History: A 26-year-old male patient with past medical history of aortic coarctation repair...

Number 09-10: An unusual complication of the Ross procedure and the role of CMR in its assessment
History: A 26 year old male had previously undergone a Ross procedure for a stenosed bicuspid aortic valve when aged 17yrs.

Number 09-08: Syncopal Event in a Case of Kawasaki's
History: Kawasaki's Disease and Atrial Septal Aneurysm. Single imaging modality for complete assessment.

Number 07-05: Double chambered Right Ventricle
History: 34-yr-old male, recurrent syncope and dyspnea

Number 07-21: An unexpected cause of ascites
History: A 31 year old male with a 2 year History of recurrent ascites, peripheral oedema and deranged LFTs. Budd-Chiari syndrome suspected. Proteinuria noted so Renal MRA requested to exclude renal vein thrombosis

Number 08-06: Coarctation & aortic stenosis?
History: A 46 year old male with 6 months breathlessness. Previous patch repair of â€œadult typeâ€ CoA.

Number 08-10: Interrupted Aortic Arch
History: 2 day old female, mild respiratory distress

Number 08-19 Diagnosing RV dilatation by CMR
History: ** Case of the year winner, 2008

e) Expert opinion – ‘How we do’

"How I do" CMR of repaired Tetralogy of Fallot (Sonya Babu-Narayan, Royal Brompton Hospital)
"How I do" CMR after atrial redirection surgery (Sonya Babu-Narayan, Royal Brompton Hospital) - large file 5Mb

f) Relevant Online Talks

Free talks

MRI in GUCH - Some movies did not play correctly during this recording
By Sonya Babu-Narayan - London, UK
Recorded at EuroCMR 2009 Athens

MRI in Complex Congenital Heart Disease
By Pierluigi Festa - Massa, Italy
Recorded at EuroCMR 2009 Athens

Cross sectional imaging for percutaneous valve implantation
By Andrew Taylor
Recorded at LondonCMR

Congenital Heart Disease in LA
By César Viegas - Argentina
Recorded at Second Latin American SCMR Chapter Meeting, 2008

Atrial and ventricular septal defects assessment and closure
By Alain Delabays
Recorded at Advanced Cardiac Imaging Course for the Interventional Cardiologist, 2008, London

Adult Congenital Heart Disease
By Mark Fogel - Children's Hospital of Philadelphi
Recorded at SCMR 2008: Technicians Workshop

Members only talks - general

Pediatric Endovascular Applications 2
By Kanishka Ratnayaka - NHLBI-National Institutes of Health
Recorded at SCMR 2010

Pediatric Endovascular Applications - King’s College London
By Reza Razavi, - King’s College London
Recorded at SCMR 2010

Post surgical aortic assessment (eg Ross, TGA after ASO, S/P Norwood, etc)
By Heynric Grotenhuis - Leiden University Medical Centre
Recorded at SCMR 2010

Aortic Valve disease (eg bicuspid, AS, AR)
By Kevin Whitehead - Childrens' Hospital of Philadelphia
Recorded at SCMR 2010

Congenital Heart Disease
By Matthias Gutberlet - University of Leipzig
Recorded at SCMR 2009 Physician preconference

Pediatric CMR
By David A. Annese - Children's Hospital Boston
Recorded at SCMR 2008: Technicians Workshop

Members only talks - cutting edge

Should All ASD/VSDs Undergo CMR Assessment for Percutaneous Valve Closure?
By Karen Ordovas - University of California
Recorded at SCMR 2009 Clinical Valvular/Haemodynamics

Does CT have a role in Valve Imaging?
By Ricardo Curry instead of Gudrun Feuchtner - Medical University, Innsbruck
Recorded at SCMR 2009 Clinical Valvular/Haemodynamics

How accurate is Velocity Coding?
By Jos Westenberg, - Leiden University Medical Centre
Recorded at SCMR 2009 Clinical Valvular/Haemodynamics

Specific aspects of pediatric imaging
By Emanuela Valsangiacomo Buchel - University Children's Hospital Zurich - Switzerland
Recorded at SCMR 2009 Physician preconference

Post-Operative Complications of Atrerial Switch Procedure
By Andrew Powell - Children's Hospital Boston
Recorded at SCMR 2009 CMR for Transposition, double-outlet Right Ventricle and Single Ventricle

CMR in the Late Evaluation of Systemic Right Ventricle-Atrial Switch Procedure and Corrected Transposition
By William A Helbing - Erasmus University Medical Center
Recorded at SCMR 2009 CMR for Transposition, double-outlet Right Ventricle and Single Ventricle

CMR Evaluation Post Correction of DORV
By Javier Ganame - University Hospitals Leuven
Recorded at SCMR 2009 CMR for Transposition, double-outlet Right Ventricle and Single Ventricle

CMR for Pre-surgical Evaluation: Single vs Two-Ventricle Approach
By Mark A Fogel - Childrens Hospital of Philadelphia
Recorded at SCMR 2009 CMR for Transposition, double-outlet Right Ventricle and Single Ventricle

Pediatric Endovascular Applications
By Boris Schmitt for Titus Kuehne - German Heart Institute
Recorded at SCMR 2009 Interventional II - iCMR Applications: Focus on EP and Pediatrics

h) Relevant papers (starting point):

Geva T, Marshall AC. Magnetic resonance imaging-guided catheter interventions in congenital heart disease. Circulation. 2006;113:1051-2.
Bandettini WP, Arai AE. Advances in clinical applications of cardiovascular magnetic resonance imaging. Heart. 2008 Nov;94(11):1485-95.
McQuillen PS. Magnetic resonance imaging in congenital heart disease: what to do with what we see and don't see? Circulation. 2009;119:660-2