DOI: 10.1148/rg.256045052
Cardiac MR Imaging and MR Angiography for Assessment of Complex Tetralogy of Fallot and Pulmonary Atresia1
M. Ines Boechat, MD,
Osman Ratib, MD, PhD,
Penny L. Williams, MD,
Antoinette S. Gomes, MD,
John S. Child, MD and
Vivekanand Allada, MD
1 From the Department of Radiological Sciences (M.I.B., O.R., P.L.W., A.S.G.), Department of Pediatrics (V.A.), and Division of Cardiology (J.S.C.), University of California at Los Angeles, David Geffen School of Medicine, 650 Charles E. Young Dr S, Box 951721, Los Angeles CA 90095-1721. Recipient of Certificate of Merit and Excellence in Design awards for an education exhibit at the 2002 RSNA Annual Meeting. Received March 24, 2004; revision requested June 3 and received April 4, 2005; accepted April 18. All authors have no financial relationships to disclose.
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Figure 1. Anterior 3D volume-rendered MR image in the coronal plane shows pulmonary atresia and nonconfluence of the left pulmonary artery (LPA) with a blind right ventricular outflow tract.
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Figure 2. Left lateral and posterior coronal 3D volume-rendered MR images show aneurysmal dilatation of the left (LPA) and right (RPA) pulmonary arteries in an adult patient with uncorrected tetralogy of Fallot and severe pulmonary valve stenosis.
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Figure 3. Posterior 3D volume-rendered MR image in the coronal plane shows an enlarged aortopulmonary collateral vessel (AP col.) supplying distal branches of the right pulmonary artery (RPA) in a patient with tetralogy of Fallot. Ao = aorta, LPA = left pulmonary artery.
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Figure 4. Dynamic cine MR images obtained in the short-axis plane at the level of the aortic outflow tract during diastole and systole show repair of a subaortic ventricular septal defect (VSD patch) and overriding aorta (Ao). LA = left atrium, LV = left ventricle.
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Figure 5. Anterior 3D volume-rendered image obtained in an adult patient 42 years after initial surgical repair of tetralogy of Fallot and reconstruction of hypoplastic pulmonary arteries shows enlarged right ventricular outflow tract (RVOT) and reconstructed right (RPA) and left (LPA) pulmonary artery branches with irregular shape but without significant narrowing or stenosis.
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Figure 6. Anterior 3D volume-rendered image, obtained after bilateral unifocalization in a patient with pulmonary atresia, shows anterior connection of the right unifocalization conduit (R. Unifoc) to the ascending aorta, and supply of the left unifocalization conduit (L. Unifoc) via a central shunt from the left subclavian artery.
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Figure 7. Anterior 3D volume-rendered image obtained after bilateral unifocalization in a patient with pulmonary atresia and nonconfluent pulmonary arteries shows supply of both unifocalization conduits via central shunts from the respective subclavian arteries.
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Figure 8. Anterior 3D volume-rendered image obtained after complete surgical repair of pulmonary atresia shows two prosthetic conduits that connect a reconstructed right ventricular outflow tract (RVOT) to the unifocalization chambers of the right (R. Conduit) and left (L. Conduit) pulmonary artery branches.
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Figure 9. Dynamic cine MR images of the heart, obtained with a fast imaging with steady-state precession sequence, provide short-axis views at the level of the right ventricular out-flow tract after surgical repair of tetralogy of Fallot. Residual valvular stenosis is indicated by a jet of low signal intensity during systole (left arrow) and by valvular regurgitation during diastole (right arrow). LV = left ventricle, PA = pulmonary artery, RV = right ventricle.
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Figure 10. Coronal thick-slab reformatted image obtained with 3D MR angiography shows residual stenosis (arrow) at the origin of the right pulmonary artery (RPA) and the main pulmonary artery (PA) after surgical repair of tetralogy of Fallot. Ao = aorta.
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Figure 11. Three-dimensional volume-rendered MR image of the origin of the left (LPA) and right (RPA) pulmonary arteries, obtained after patch enlargement of the right ventricular outflow tract (RVOT) in a patient with tetralogy of Fallot, shows segmental narrowing (white arrow) of the left pulmonary artery.
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Figure 12. Coronal anterior thick-slab reformatted MR image shows bilateral unifocalization, with the right unifocalization conduit (R. Unifoc) connected to the ascending aorta via a short central shunt in which there is a mild-to-moderate segmental stenosis. L. Unifoc = left unifocalization conduit.
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Figure 13. Right anterior oblique 3D volume-rendered MR image shows aneurysmal dilatation of a central shunt that connects a right unifocalization conduit (R. Unifoc) to the ascending aorta.
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Figure 14. Dynamic cine MR images obtained along the long axis during diastole and systole show aneurysmal dilatation of a right ventricular outflow tract patch (arrow). Ao = aorta, RA = right atrium, RV = right ventricle.
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Figure 15. Coronal thick-slab reformatted MR image shows an atretic main pulmonary artery (MPA) segment with severe stenosis (arrow) at its junction with the left (LPA) and right (RPA) pulmonary artery branches.
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Copyright © 2005 by the Radiological Society of North America.
