Management of Patients With Single-Ventricle Physiology Across the Lifespan: Contributions From Magnetic Resonance and Computed Tomography Imaging |
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| Affiliation: | 1. Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada;2. Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada;3. Peter Munk Cardiac Centre, University Health Network,University of Toronto, Toronto, Ontario, Canada;1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA;2. Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA;1. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada;2. School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada;3. Child Health Evaluative Science, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada;4. Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada;5. Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada;1. Jewish General Hospital, MAUDE Unit, McGill University, Montréal, Québec, Canada;2. Toronto Adult Congenital Heart Disease Program, Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada;3. University Health Network, Toronto, Ontario, Canada;4. Ohio State University Medical Center, Columbus, Ohio, USA;5. St. Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada;6. Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada;7. McGill University Health Centre, Montréal, Québec, Canada;1. Structural Heart Intervention Program, Université de Montréal, Montréal, Québec, Canada;2. Cardiology Division, Geneva University Hospitals, Geneva, Switzerland;3. Adult Congenital Heart Centre, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada;4. Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium;5. Department of Cardiac Surgery, CHU Sainte Justine, Université de Montréal, Montréal, Québec, Canada;6. Division of Pediatric Cardiology, CHU Sainte Justine, Université de Montréal, Montréal, Québec, Canada;1. Heart Centre, Department of Clinical Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands;2. Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands;3. Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands;4. Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;5. Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands |
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| Abstract: | Cardiovascular magnetic resonance (CMR) and cardiac computed tomography (CCT) are robust cross-sectional imaging modalities that are increasingly being used to guide the diagnosis and management of those born with single-ventricle physiology. The purpose of this review is to acquaint the reader with the wide range of cross-sectional imaging applications that can be applied in this population. Illustrative examples of information provided by CMR and CCT are included, such as delineation of cardiac anatomy, measurement of ventricular volumetry, interrogation of vascular anatomy and flows, evaluation of myocardial viability, and exclusion of thromboembolic disease. Focus is placed on the appropriate selection and timing of advanced cardiac imaging modalities, and differentiations are made between established indications for imaging and emerging applications (such as 4-dimensional [4D] flow assessment and parametric imaging for identification of diffuse fibrosis using CMR). Potential CMR and CCT contributions in the selection of interventional strategies in the child and for surveillance of postoperative complications in the adult are highlighted. Furthermore, the importance of extracardiac cross-sectional imaging in the single-ventricle population is emphasized given the recognition that complications post-Fontan palliation are not limited to the cardiovascular system but will often include extracardiac manifestations of disease (such as hepatic disease or lymphatic abnormalities), While the value of CMR and CCT for contemporary clinical care of individuals born with single-ventricle physiology appears to be well-established, further research will be necessary to explore the impact of risk stratification using imaging biomarkers on clinical outcomes following Fontan palliation. |
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