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      Recommendations for cardiovascular magnetic resonance in adults with congenital heart disease from the respective working groups of the European Society of Cardiology

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          Abstract

          This paper aims to provide information and explanations regarding the clinically relevant options, strengths, and limitations of cardiovascular magnetic resonance (CMR) in relation to adults with congenital heart disease (CHD). Cardiovascular magnetic resonance can provide assessments of anatomical connections, biventricular function, myocardial viability, measurements of flow, angiography, and more, without ionizing radiation. It should be regarded as a necessary facility in a centre specializing in the care of adults with CHD. Also, those using CMR to investigate acquired heart disease should be able to recognize and evaluate previously unsuspected CHD such as septal defects, anomalously connected pulmonary veins, or double-chambered right ventricle. To realize its full potential and to avoid pitfalls, however, CMR of CHD requires training and experience. Appropriate pathophysiological understanding is needed to evaluate cardiovascular function after surgery for tetralogy of Fallot, transposition of the great arteries, and after Fontan operations. For these and other complex CHD, CMR should be undertaken by specialists committed to long-term collaboration with the clinicians and surgeons managing the patients. We provide a table of CMR acquisition protocols in relation to CHD categories as a guide towards appropriate use of this uniquely versatile imaging modality.

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          Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report.

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            Ventricular fibrosis suggested by cardiovascular magnetic resonance in adults with repaired tetralogy of fallot and its relationship to adverse markers of clinical outcome.

            Late morbidity and mortality remain problematic after repair of tetralogy of Fallot (TOF). We hypothesized that fibrosis detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) would be present in adults with repaired TOF and would be related to adverse markers of outcome. LGE was scored in the right and left ventricles (RV and LV) of 92 adult patients who had undergone TOF repair. RV LGE was seen in all patients at surgical sites located in the outflow tract (99%) or the site of ventricular septal defect patching (98%) and in the inferior RV insertion point (79%) and trabeculated myocardium (24%). LV LGE (53%) was located at the apex consistent with apical vent insertion (49%), in the inferior or lateral wall consistent with infarction (5%), or in other areas (8%). Patients with supramedian RV LGE score were older (38 versus 27 years, P<0.001) and more symptomatic (38% versus 8% in New York Heart Association class II or greater, P=0.001), had increased levels of atrial natriuretic peptide (7.3 versus 4.9 pmol/L, P=0.041), and had a trend to higher brain natriuretic peptide (12.3 versus 7.2 pmol/L, P=0.086), exercise intolerance (maximum VO2 24 versus 28 mL.min(-1).kg(-1), P=0.021), RV dysfunction (RV end-systolic volume 61 versus 55 mL/m2, P=0.018; RV ejection fraction 50% versus 56%, P=0.007), and clinical arrhythmia (26% versus 10%, P=0.039). Non-apical vent LV LGE also correlated with markers of adverse outcome. In a multivariate model, RV LGE remained a predictor of arrhythmia. RV and LV LGE were common after TOF repair and were related to adverse clinical markers, including ventricular dysfunction, exercise intolerance, and neurohormonal activation. Furthermore, RV LGE was significantly associated with clinical arrhythmia.
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              Radiation dose to patients from cardiac diagnostic imaging.

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                Author and article information

                Journal
                Eur Heart J
                eurheartj
                ehj
                European Heart Journal
                Oxford University Press
                0195-668X
                1522-9645
                April 2010
                11 January 2010
                11 January 2010
                : 31
                : 7
                : 794-805
                Affiliations
                [1 ]CMR Unit, simpleRoyal Brompton Hospital , London SW3 6NP, UK
                [2 ]Division of Non-Invasive Imaging, Havard Medical School, simpleChilden's Hospital Boston, Harvard Medical School , Boston, MA, USA
                [3 ]Department of Pediatric Cardiology and Congenital Heart Disease, simpleDeutsches Herzzentrum , Munich, Germany
                [4 ]Cardiovascular Center, simpleUniversity Hospital , Zurich, Switzerland
                [5 ]simpleUniversity Hospital , Lausanne, Switzerland
                [6 ]simpleCincinnati Children's Hospital , Cincinnati, OH, USA
                Author notes
                [* ]Corresponding author. Tel: +44 207 351 8808, Fax: +44 207 351 8816, Email: p.kilner@ 123456rbht.nhs.uk
                [†]

                Representing the CMR Working Group of the European Society of Cardiology.

                [‡]

                Representing the GUCH Working Group of the European Society of Cardiology.

                Article
                ehp586
                10.1093/eurheartj/ehp586
                2848324
                20067914
                e75ae960-02fe-4477-afc4-9134055b66ca
                Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2010. For permissions please email: journals.permissions@oxfordjournals.org.

                The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

                History
                : 27 August 2009
                : 9 November 2009
                : 7 December 2009
                Categories
                Special Article

                Cardiovascular Medicine
                aortic coarctation,transposition of the great arteries,adult congenital heart disease,atrial septal defect,imaging,tetralogy of fallot,cardiovascular magnetic resonance,ventricular septal defect

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