Fetal echocardiography--four years experience in Bristol

Fetal echocardiography is described as a reliable method for detecting major structural cardiac abnormalities but relatively few hospitals offer the investigation. We report the results of fetal echocardiography in 110 pregnancies referred to our cardiac ultrasound service. Standard imaging techniques were used and scanning was carried out at 18-24 weeks gestation in the majority. Most referrals were made with a history of congenital heart disease in a sibling or close relative, the remainder followed abnormal routine scans or for other reasons. Four structural cardiac abnormalities were diagnosed in the routine scan abnormality group and one in the positive family history group. Referring clinicians reported no subsequent cardiac abnormality following normal scans. We confirm that provided a careful and systematic technique is used fetal echocardiography is reliable in detecting major structural cardiac defects. Particular attention should be paid to the fetal heart in patients with previously abnormal routine scans as this group accounts for the majority of detected congenital cardiac anomalies.     

胎儿胸部异常的MRI诊断

目的:分析9例胎儿胸部异常的MRI表现,探讨MRI在胎儿胸部异常诊断中的补充作用。方法:对9例产前超声检查发现的胎儿胸部异常病例,经孕母及家属同意后行胎儿多平面的MRT2WI扫描,部分病例加做T1WI扫描,对胎儿异常胸部MRI表现进行研究,进一步确定胸部异常类型。结果:9例胸部异常中,6例先天性肺囊腺瘤样畸形(CCAM),3例为右肺CCAM,3例为左肺CCAM,MRI表现为患侧肺内多囊样T2WI高信号改变,病侧肺体积增大,纵隔向对侧移位;1例为左侧先天性膈疝(CDH),MRI示左侧胸腔内正常肺组织消失,呈混杂肠腔信号,肺尖少许正常肺组织受压;2例为胸腔积液,1例表现为双侧胸水、腹水、睾丸鞘膜积液,考虑为胎儿免疫性水肿,另1例为右侧胸水、腹水、皮下软组织水肿。结论:MRI作为产科胎儿超声检查的一种重要补充方法,对病变多方位的显示,具有很高的价值,给临床诊断及治疗予以很大帮助。     

Magnetic resonance imaging of congenital abnormalities of the thoracic aorta

This article outlines the ability of MR imaging in the detection and presurgical evaluation of congenital abnormalities of the thoracic aorta (CATA). Congenital abnormalities of the thoracic aorta may be found incidentally on chest radiographs in patients without symptoms, or it can be associated with clinical findings which are very variable depending on the association with congenital cardiac malformations or vascular ring. When CATA is suspected as the cause of anomalies in the mediastinum in asymptomatic patients, confirmation of the abnormality should be by MR imaging allowing precise evaluation of the thoracic aorta and origin of the principal arteries. When CATA is considered because clinical findings indicate coarctation of the aorta, vascular ring or associated cardiac disorder, evaluation with ultrasound can be complemented by MR, which in most cases will replace the diagnostic catheterization. Received 2 April 1997; Revision received 14 July 1997; Accepted 12 September 1997     

CT demonstration of cardiac structures.

Cross-sectional cardiac anatomy was studied by computed tomography (CT) in normal patients and in patients with well documented cardiac pathology. Specific cardiac chambers, aortic and pulmonary artery enlargement, ventricular aneurysms, coronary artery, and intracardiac calcifications were demonstrated using a 3 sec scan time with and without intravenous iodinated contrast media. Although CT imaging of the heart is in its infancy, the clarity with which cardiac chambers and other structures were visualized is encouraging and suggests the potential value of CT scanning for detecting significant intracardiac pathology on routine thoracic CT scans.     

Double outlet right ventricle presenting in an adult woman: a case report

Double outlet right ventricle (DORV) is a congenital cardiac malformation that occurs in 1%-3% of individuals with congenital heart defects. Cardiac magnetic resonance imaging (MRI) may play an important role in the anatomy of the ventricular septal defect, functional status of both ventricles, and in identifying any residual stenosis or regurgitation or coexistent anomalies. Here, we present a case of a 28-years-old woman who came to our emergency department with shortness of breath. The patient felt shortness of breath on exertion and improved with rest. Clinical examination showed no abnormalities except low oxygen saturation of 65%. After echocardiography and cardiac MRI were done, it was concluded that she had a double outlet right ventricle with peri membranous ventricular septal defect (VSD), pulmonary hypertension, and pericardial effusion. This study highlights the role of cardiac MRI in assessing DORV.     

Evaluation of congenital heart disease by magnetic resonance imaging

Magnetic resonance imaging has proven to be useful in the assessment of patients with complex congenital heart disease and in the post-surgical follow-up of patients with corrected congenital heart disease. A thorough understanding of the congenital cardiac malformations that can be encountered is needed and the use of the sequential segmental analysis helps to standardize the evaluation and diagnosis of (complex) congenital heart disease. After surgical correction of congenital heart defects, patients must be followed over extended periods of time, because morphological and functional abnormalities may still be present or may develop. The use of echocardiography may be hampered in these patients as scar tissue and thorax deformities limit the acoustic window. Magnetic resonance imaging has proven to be advantageous in the follow-up of these post-surgical patients and with the use of several different techniques the morphological as well as functional abnormalities can be evaluated and followed over time.     

Ultrasonographically normal fetal heart

The fetal heart must be systematically checked in routine ultrasonographic examination to detect any cardiac abnormality. The quality of the examination requires good knowledge of development and anatomy of the fetal heart. A complete examination will study inflow and outflow tracts: inflow tract on the four-chamber view, outflow tract by a static and dynamic study of the great arteries (on section in fetal axial and saggital planes). All cardiac abnormalities indicate the need for a fetal karyotype after a complete morphologic study. Atrioventricular septal defect (ASD) for Down's syndrome and malaligment septal defect of cono-truncal pathology are both excellent signs of chromosome abnormality. Special attention must be paid to cardiac abnormalities without a prenatal diagnosis due to the prognosis risk: complete transposition and total abomalous venous connection. These cardiac abnormalities, as well as complex isolated congenital heart disease, require a cardiopediatric evaluation to determine prognosis and management strategy.     

Angeborene Fehlbildungen der Aorta im Kindes- und Jugendalter

Aortic abnormalities are common cardiovascular malformations accounting for 15-20% of all congenital heart disease. Ultrafast CT and MR imaging are noninvasive, accurate and robust techniques that can be used in the diagnosis of aortic malformations. While their sensitivity in detecting vascular abnormalities seems to be as good as that of conventional catheter angiocardiography, at over 90%, they are superior in the diagnosis of potentially life-threatening complications, such as tracheal, bronchial, or esophageal compression. It has been shown that more than 80% of small children with aortic abnormalities benefit directly from the use of noninvasive imaging: either cardiac catheterization is no longer necessary or radiation doses and periods of general anesthesia for interventional catheterization procedures can be much reduced.The most important congenital abnormalities of the aorta in children and adolescents are presented with reference to examples, and the value of CT and MR angiography is documented.     

Postoperative evaluation of congenital heart disease by magnetic resonance imaging.

In the last four decades the survival of patients with corrected or palliated congenital heart disease has increased dramatically. However, post-operative abnormalities frequently occur and therefore a noninvasive imaging tool is mandatory for the timely detection of morphological as well as functional abnormalities. Magnetic resonance imaging (MRI) is ideally suited for the noninvasive diagnosis and post-operative follow-up of congenital heart disease. Spin-echo MRI is able to visualize structures that may be difficult to assess with other noninvasive image modalities and is sensitive in the detection of post-interventional stenoses or aneurysms. Because the function of the ventricles may deteriorate over time after correction or palliation of a congenital cardiac malformation, the use of gradient-echo MRI is essential in the follow-up after correction or palliation, as no other conventional technique allows such detailed evaluation of ventricular function, without geometrical assumptions. Phase-contrast MRI is well suited to assess valvular function, allowing accurate measurement of regurgitation or stenosis. Shunt quantification is another application of phase-contrast MRI. J. Magn. Reson. Imaging 1999;10:656-666.     

Die Computertomographie bei der Bildgebung von Kindern mit kongenitalen Herzvitien

Congenital heart diseases are the most common congenital abnormalities of development. In general, echocardiography and cardiac catheter angiography are considered the gold standard for the evaluation of congenital heart disease. Cardiac magnetic resonance imaging has become an important supplementary imaging modality because of its ability to provide an accurate morphological and functional evaluation. The role of cardiac computed tomography in the imaging of patients with congenital heart disease is becoming increasingly more important due to the development of low radiation dose protocols and improvements in the spatial and temporal resolution. In the preoperative depiction and follow-up after surgical repair of congenital heart diseases, cardiac computed tomography provides detailed information of the heart, the venous and arterial pulmonary circulation as well as systemic arteries. This article reviews the technical aspects of cardiac CT and the modification of examination protocols according to the expected pathology and patient age. The potentials and limitations of the various radiation dose reduction strategies are outlined.     

产前超声筛查胎儿先天性心脏病的临床价值分析

目的探讨胎儿超声心动图(FECG)产前筛查胎儿先天性心脏病(CHD)的临床应用价值。方法采用四腔心、左室流出道、右室流出道、三血管切面四切面法,对6 500例孕20～41周孕妇进行产前FECG筛查,以引产后尸解或产后新生儿ECG作为对照标准。结果 6 500例胎儿中,检出胎儿心脏异常69例,包括复杂性先天心脏病部分合并心外畸形39例。结论四切面检查方法简便可靠,是显示胎儿心脏结构及产前筛查胎儿CHD的重要影像诊断方法。     

胎儿复杂先天性心脏病超声分段诊断价值

目的：探讨胎儿复杂先天性心脏病（先心病）超声分段诊断价值。方法：2003年3月-2008年10月22160例接受胎儿心脏超声筛查的孕妇,取胎儿心脏超声筛查的5个标准切面,发现异常时根据心脏节段进行扫查,并叠加彩色多酱勒血流显像,观察各房室及大动脉血流分布和血流方向,综合分析先心病类型。结果：22160例胎儿中检出复杂先天性心脏病62例,其中21例合并心外畸形。43例在本院引产,23例尸检,其中22例尸检与产前超声诊断相符,1例右室双出口误诊为法洛四联症。结论：复合性先心病的畸形复杂,变化较多,以超声分段诊断方法结合彩色多普勒超声可提高复杂先心病的检出率及诊断准确性。     

Oblique chest film: value in routine and selective use

A retrospective analysis is presented of 308 consecutive cases in which four views of the chest (right and left anterior oblique, posteroanterior, and lateral) were obtained. Most cases (257) were from adult cardiac clinics or thoracic surgery clinics, where the indications were for questionable cardiac abnormality, known cardiac abnormality, or thoracic malignancy. Fewer cases (37) were studied to attempt clarification of possible abnormality on routine films. Of the 257 routine studies, the oblique views yielded no further information in 97.6% of cases, and missed lesions in 1.3%. In the selective group, the oblique views provided information or confirmatory evidence in about 95% of cases when requested by radiologists. The results throw considerable doubt on the value of oblique films in routine studies, but suggest that they may still have a value in delineating possible abnormalities seen on other views or in cases of pleural disease.     

3-Tesla-Magnetresonanztomographie zur Untersuchung von Kindern und Erwachsenen mit angeborenen Herzfehlern

Cardiovascular magnetic resonance imaging (CMR) has become a routinely used imaging modality for congenital heart disease. A CMR examination allows the assessment of thoracic anatomy, global and regional cardiac function, blood flow in the great vessels and myocardial viability and perfusion. In the clinical routine cardiovascular MRI is mostly performed at field strengths of 1.5 Tesla (T). Recently, magnetic resonance systems operating at a field strengths of 3 T became clinically available and can also be used for cardiovascular MRI. The main advantage of CMR at 3 T is the gain in the signal-to-noise ratio resulting in improved image quality and/or allowing higher acquisition speed. Several further differences compared to MRI systems with lower field strengths have to be considered for practical applications. This article describes the impact of CMR at 3 T in patients with congenital heart disease by meanings of methodical considerations and case studies.     

Computed tomography of partial anomalous pulmonary venous connection in adults

OBJECTIVES: To systematically describe the imaging features and clinical correlates of a partial anomalous pulmonary venous connection diagnosed on computed tomography (CT) in adults. METHODS: Twenty-nine adults with a partial anomalous pulmonary venous connection on CT were retrospectively identified. There were 19 women and 10 men, with a mean age of 53 (range: 19-83) years. Four cases were identified by review of 1825 consecutive chest CT reports from July 2000-July 2001, and 25 cases were culled from chest radiology teaching files at 3 institutions. Inclusion criteria were availability of CT images and medical charts. Chest radiographs (25 of 29 cases) were reviewed for mediastinal contour abnormalities, heart size, and pulmonary vascular pattern. Chest CT scans were reviewed for location, size, and drainage site of the anomalous vein; presence or absence of a pulmonary vein in the normal location; cardiac size and configuration; and pulmonary vasculature. Charts were reviewed for evidence of pulmonary and cardiovascular disease, history of congenital heart disease, and results of other cardiac imaging. RESULTS: The prevalence of a partial anomalous pulmonary venous connection was 0.2% (4 of 1825 chest CT reports). Seventy-nine percent (23 of 29 patients) had an anomalous left upper lobe vein connecting to a persistent left vertical vein, only 5% (1 of 23 patients) of whom had a left upper lobe vein in the normal location. Seventeen percent (5 of 29 patients) had an anomalous right upper lobe vein draining into the superior vena cava, 60% (3 of 5 patients) of whom also had a right upper lobe pulmonary vein in the normal location. One patient (3%) had an anomalous right lower lobe vein draining into the suprahepatic inferior vena cava. Chest radiographic findings were abnormal left mediastinal contour in 64% (15 of 25 patients), abnormal right mediastinal contour in 8% (2 of 25 patients), and cardiomegaly in 24% (6 of 25 patients). Computed tomography findings were cardiomegaly in 48% (14 of 29 patients), right atrial enlargement in 31% (9 of 29 patients), right ventricular enlargement in 31% (9 of 29 patients), and pulmonary artery enlargement in 14% (4 of 29 patients). Pulmonary or cardiovascular symptoms were present in 69% (20 of 29 patients), 55% (11 of 20 patients) of whom had specific alternative diagnoses (excluding congestive heart failure and pulmonary hypertension) to explain the symptoms. Only 1 patient (3%) was diagnosed with a secundum atrial septal defect. CONCLUSIONS: A partial anomalous pulmonary venous connection was seen in 0.2% of adults on CT. In contrast to previous series focusing on children, the anomalous vein in adults was most commonly from the left upper lobe, in women, and infrequently associated with atrial septal defects.     

Anatomical associations and radiological characteristics of Scimitar syndrome on CT and MR

PurposeTo report the anatomical associations and radiological characteristics of Scimitar syndrome on CT and MR.Materials and methodsRetrospective review of the medical records between February 2001 and February 2016 was performed. To identify patients, radiological reports were queried for “Scimitar” or “partial anomalous pulmonary venous return.” Patients with radiological findings of Scimitar syndrome were included. Patients without cross-sectional imaging were excluded. Patients' demographics, radiologic images, and medical notes were reviewed. Two radiologists re-read the available imaging studies. Images were reviewed for Scimitar syndrome confirmation, number and location of Scimitar vein drainage, number of lobes drained by the Scimitar vein, and right pulmonary artery and lung hypoplasia. In addition, the number of pulmonary veins draining into the left atrium, left sided anomalous pulmonary veins, congenital heart disease, aortic arch anomalies, cardiac dextroposition, right ventricular enlargement, pulmonary artery enlargement, and elevated QP:QS ratios were identified. Other associated anomalies including the presence of an anomalous feeding artery and pulmonary sequestration, abnormal lobar pattern, localized bronchiectasis, horseshoe lung, accessory diaphragm, diaphragmatic hernia, vertebral anomalies, and genitourinary tract anomalies were reviewed.ResultsSixteen patients (3 males, 13 females; mean age 39.5 years, range 14 days–72 years) with confirmed Scimitar syndrome on CT and MR imaging were identified. The Scimitar vein drained to the infra-diaphragmatic inferior vena cava (IVC) in ten patients and to the supra-diaphragmatic IVC in six patients. The most common associated anomalies were right ventricle enlargement (93.3%), variant lobar pattern of the right lung (92.9%), enlarged pulmonary arteries (60%), and cardiac dextroposition (50%).ConclusionRecognizing the radiologic characteristics and anatomical associations of Scimitar syndrome is important as features of the primary condition and associated anomalies may have implications in surgical management.     

CT imaging in congenital heart disease: An approach to imaging and interpreting complex lesions after surgical intervention for tetralogy of Fallot,transposition of the great arteries,and single ventricle heart disease

Echocardiography and cardiac magnetic resonance imaging are the most commonly performed diagnostic studies in patients with congenital heart disease. A small percentage of patients with congenital heart disease will be referred to cardiac CT subsequent to echocardiography when magnetic resonance imaging is insufficient, contraindicated, or considered high risk. The most common complex lesions referred for CT at our institution are tetralogy of Fallot, transposition complexes, and single ventricle heart disease. This review discusses the most common surgical procedures performed in these patients and the technical considerations for optimal image acquisition on the basis of the prior procedure and the individual patient history. Cardiac CT can provide the functional and anatomic information required for decision making in complex congenital heart disease. Image interpretation is aided by knowledge of the common approaches to operative repair and the residual hemodynamic abnormalities. Acquisition and interpretation that is both individualized to the patient's underlying disease and the specific clinical question is likely to maintain diagnostic accuracy while decreasing the potential risk of cardiac CT.     

Congenital diseases of the thoracic aorta. Role of MRI and MRA

Aortic malformations may be associated with other congenital heart abnormalities or may present independently, as incidental findings in asymptomatic patients. For more than 30 years, conventional imaging techniques for detection and assessment of congenital anomalies of the aorta have been chest X-ray, echocardiography and angiography. In recent times, considerable interest in congenital aortic diseases has been shown, due to technical progresses of noninvasive imaging modalities. Among them, magnetic resonance imaging (MRI) almost certainly offers the greatest advantages, especially in young patients in which a radiation exposure must be avoided as much as possible. MRI provides an excellent visualization of vascular structures with a wide field of view, well suited for evaluation of the thoracic aorta malformations. With the implementation of magnetic resonance angiography (MRA) it is also possible to depict any relationship with supra-aortic or mediastinal vessels. Phase contrast technique allows identification of the hemodynamic significance of the aortic alteration. Some technical considerations, which include fast spin-echo, gradient-echo and, especially, MRA techniques with phase-contrast and contrast enhanced methods, are discussed and applied in the evaluation of congenital thoracic aorta diseases.     

Phase abnormalities in right heart studies. Demonstration of six different patterns

Phase imaging abnormalities of the right side of the heart detected on multiple gated blood pool angiography (MUGA) have received less attention than similar abnormalities of the left ventricle. It has been found that certain different patterns of phase abnormalities of both right ventricle and right atrium are useful in the detection of six pathological conditions: right bundle branch block, ischemic right coronary artery disease, pericardial effusion, tricuspid regurgitation, pulmonary hypertension, and atrial septal defect. The authors emphasize the importance of these abnormal phase patterns during interpretation of gated cardiac studies, as they are helpful in directing the physicians attention towards the proper diagnosis.     

Radiographic changes in cardiac contours following heart transplantation. Clarification by MR imaging

Chest radiographs of 46 patients who had undergone heart transplantation were reviewed with special attention to abnormalities of the cardiac contours. MR imaging in 3 such patients revealed 3 types of double right cardiac contours: the recipient right atrium combined with the donor right atrium; the donor right atrium combined with the recipient left atrium; and a cardiac fat pad combined with the right atrium. A prominent main pulmonary artery was shown by MR imaging to result from leftward displacement of the main pulmonary artery caused by clockwise rotation and transverse position of the transplanted heart. Recognition of these unique radiographic appearances is of value in assessing transplanted hearts and in avoiding misdiagnosis.