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Cardiovascular MR Imaging in Neonates and Infants with Congenital Heart Disease¹

¹ From the Department of Diagnostic Imaging (C.J.K.) and the Division of Paediatric Cardiology (E.R.V.B.), University Children’s Hospital, Stein-wiesstrasse 75, CH 8032 Zürich, Switzerland; and the Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada (S.-J.Y.). Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received March 16, 2006; revision requested May 22 and received July 14; accepted July 20. All authors have no financial relationships to disclose.

View larger version (81K): [in this window] [in a new window] [Download PPT slide]   Figure 1a.  Interrupted aortic arch in a 3-day-old girl with transposition of the great arteries, ventricular septum defects (VSDs), and an atrial septum defect (ASD). Severe aortic coarctation and a hypoplastic right ventricle were suspected at echocardiography. (a) VR MR angiographic image demonstrates a type A interrupted aortic arch. Transposition of the great arteries, with the aorta (AO) arising from the right ventricle (RV) and the pulmonary trunk (MPA) from the left ventricle (LV), is clearly depicted. PDA = patent ductus arteriosus. (b) Horizontal long-axis cine image shows multiple VSDs and the ASD (arrows). LV = left ventricle, RV = right ventricle. (See also Movie 1 at radiographics.rsnajnls.org/cgi/content/full/27/1/5/DC1.) (c) Short-axis cine images with measurement of the end-diastolic volumes show equal-sized ventricles, thereby helping rule out right ventricular hypoplasia. BSA = body surface area, LV = left ventricle (outlined in red), RV = right ventricle (outlined in yellow). On the basis of the MR imaging findings and without further cardiac catheterization, surgical correction of the aortic arch and pulmonary banding were performed on day 4. Biventricular repair with an arterial switch procedure and closure of the VSDs and ASD were performed 3 weeks later.

 

View larger version (136K): [in this window] [in a new window] [Download PPT slide]   Figure 1b.  Interrupted aortic arch in a 3-day-old girl with transposition of the great arteries, ventricular septum defects (VSDs), and an atrial septum defect (ASD). Severe aortic coarctation and a hypoplastic right ventricle were suspected at echocardiography. (a) VR MR angiographic image demonstrates a type A interrupted aortic arch. Transposition of the great arteries, with the aorta (AO) arising from the right ventricle (RV) and the pulmonary trunk (MPA) from the left ventricle (LV), is clearly depicted. PDA = patent ductus arteriosus. (b) Horizontal long-axis cine image shows multiple VSDs and the ASD (arrows). LV = left ventricle, RV = right ventricle. (See also Movie 1 at radiographics.rsnajnls.org/cgi/content/full/27/1/5/DC1.) (c) Short-axis cine images with measurement of the end-diastolic volumes show equal-sized ventricles, thereby helping rule out right ventricular hypoplasia. BSA = body surface area, LV = left ventricle (outlined in red), RV = right ventricle (outlined in yellow). On the basis of the MR imaging findings and without further cardiac catheterization, surgical correction of the aortic arch and pulmonary banding were performed on day 4. Biventricular repair with an arterial switch procedure and closure of the VSDs and ASD were performed 3 weeks later.

 

View larger version (59K): [in this window] [in a new window] [Download PPT slide]   Figure 1c.  Interrupted aortic arch in a 3-day-old girl with transposition of the great arteries, ventricular septum defects (VSDs), and an atrial septum defect (ASD). Severe aortic coarctation and a hypoplastic right ventricle were suspected at echocardiography. (a) VR MR angiographic image demonstrates a type A interrupted aortic arch. Transposition of the great arteries, with the aorta (AO) arising from the right ventricle (RV) and the pulmonary trunk (MPA) from the left ventricle (LV), is clearly depicted. PDA = patent ductus arteriosus. (b) Horizontal long-axis cine image shows multiple VSDs and the ASD (arrows). LV = left ventricle, RV = right ventricle. (See also Movie 1 at radiographics.rsnajnls.org/cgi/content/full/27/1/5/DC1.) (c) Short-axis cine images with measurement of the end-diastolic volumes show equal-sized ventricles, thereby helping rule out right ventricular hypoplasia. BSA = body surface area, LV = left ventricle (outlined in red), RV = right ventricle (outlined in yellow). On the basis of the MR imaging findings and without further cardiac catheterization, surgical correction of the aortic arch and pulmonary banding were performed on day 4. Biventricular repair with an arterial switch procedure and closure of the VSDs and ASD were performed 3 weeks later.

 

View larger version (152K): [in this window] [in a new window] [Download PPT slide]   Figure 2a.  Aortic coarctation in a 6-day-old girl with hypoplastic left heart complex. MR imaging was requested to help decide whether to perform biventricular or univentricular repair. (a, b) Short-axis (a) and horizontal long-axis (b) cine images demonstrate a small left ventricle (LV), a small mitral valve annulus (**), and a muscular inlet VSD (*). LA = left atrium, RA = right atrium, RV = right ventricle. (c) Posterior VR MR angiographic image shows a patent ductus arteriosus, tubular hypoplasia of the aortic arch, and the coarctation (arrow). On the basis of the MR imaging measurements of the left ventricular end-diastolic volume (20 mL/m2 body surface area) and the mitral valve annulus area (2.8 cm2/m2 body surface area), the left ventricle was judged to be large enough for biventricular repair. The patient successfully underwent closure of the VSD and repair of the aortic arch.

 

View larger version (153K): [in this window] [in a new window] [Download PPT slide]   Figure 2b.  Aortic coarctation in a 6-day-old girl with hypoplastic left heart complex. MR imaging was requested to help decide whether to perform biventricular or univentricular repair. (a, b) Short-axis (a) and horizontal long-axis (b) cine images demonstrate a small left ventricle (LV), a small mitral valve annulus (**), and a muscular inlet VSD (*). LA = left atrium, RA = right atrium, RV = right ventricle. (c) Posterior VR MR angiographic image shows a patent ductus arteriosus, tubular hypoplasia of the aortic arch, and the coarctation (arrow). On the basis of the MR imaging measurements of the left ventricular end-diastolic volume (20 mL/m2 body surface area) and the mitral valve annulus area (2.8 cm2/m2 body surface area), the left ventricle was judged to be large enough for biventricular repair. The patient successfully underwent closure of the VSD and repair of the aortic arch.

 

View larger version (142K): [in this window] [in a new window] [Download PPT slide]   Figure 2c.  Aortic coarctation in a 6-day-old girl with hypoplastic left heart complex. MR imaging was requested to help decide whether to perform biventricular or univentricular repair. (a, b) Short-axis (a) and horizontal long-axis (b) cine images demonstrate a small left ventricle (LV), a small mitral valve annulus (**), and a muscular inlet VSD (*). LA = left atrium, RA = right atrium, RV = right ventricle. (c) Posterior VR MR angiographic image shows a patent ductus arteriosus, tubular hypoplasia of the aortic arch, and the coarctation (arrow). On the basis of the MR imaging measurements of the left ventricular end-diastolic volume (20 mL/m2 body surface area) and the mitral valve annulus area (2.8 cm2/m2 body surface area), the left ventricle was judged to be large enough for biventricular repair. The patient successfully underwent closure of the VSD and repair of the aortic arch.

 

View larger version (143K): [in this window] [in a new window] [Download PPT slide]   Figure 3a.  Aortic coarctation in a 3-week-old girl with an atrioventricular septum defect (AVSD). Pulmonary vein anomalies were suspected at echocardiography. (a) Horizontal long-axis cine image shows the AVSD (**). LV = left ventricle, RV = right ventricle. (b–d) Posterior VR (b, c) and anterior subvolume MIP (d) MR angiographic images show a patent ductus arteriosus, a hypoplastic aortic arch, and the coarctation (arrow in b). The pulmonary vein anatomy is clearly defined as a common orifice of the left pulmonary veins—which is also stenotic (arrow in c)—and an anomalous connection of the right upper pulmonary vein (* in c and d) to the superior vena cava. AO = aorta, LPA = left pulmonary artery, RA = right atrium, RPA = right pulmonary artery. On the basis of the MR imaging findings, the coarctation was first repaired, and 3 weeks later, at the time of the AVSD repair, the left pulmonary veins were augmented and the right upper pulmonary vein was reimplanted into the left atrium.

 

View larger version (165K): [in this window] [in a new window] [Download PPT slide]   Figure 3b.  Aortic coarctation in a 3-week-old girl with an atrioventricular septum defect (AVSD). Pulmonary vein anomalies were suspected at echocardiography. (a) Horizontal long-axis cine image shows the AVSD (**). LV = left ventricle, RV = right ventricle. (b–d) Posterior VR (b, c) and anterior subvolume MIP (d) MR angiographic images show a patent ductus arteriosus, a hypoplastic aortic arch, and the coarctation (arrow in b). The pulmonary vein anatomy is clearly defined as a common orifice of the left pulmonary veins—which is also stenotic (arrow in c)—and an anomalous connection of the right upper pulmonary vein (* in c and d) to the superior vena cava. AO = aorta, LPA = left pulmonary artery, RA = right atrium, RPA = right pulmonary artery. On the basis of the MR imaging findings, the coarctation was first repaired, and 3 weeks later, at the time of the AVSD repair, the left pulmonary veins were augmented and the right upper pulmonary vein was reimplanted into the left atrium.

 

View larger version (174K): [in this window] [in a new window] [Download PPT slide]   Figure 3c.  Aortic coarctation in a 3-week-old girl with an atrioventricular septum defect (AVSD). Pulmonary vein anomalies were suspected at echocardiography. (a) Horizontal long-axis cine image shows the AVSD (**). LV = left ventricle, RV = right ventricle. (b–d) Posterior VR (b, c) and anterior subvolume MIP (d) MR angiographic images show a patent ductus arteriosus, a hypoplastic aortic arch, and the coarctation (arrow in b). The pulmonary vein anatomy is clearly defined as a common orifice of the left pulmonary veins—which is also stenotic (arrow in c)—and an anomalous connection of the right upper pulmonary vein (* in c and d) to the superior vena cava. AO = aorta, LPA = left pulmonary artery, RA = right atrium, RPA = right pulmonary artery. On the basis of the MR imaging findings, the coarctation was first repaired, and 3 weeks later, at the time of the AVSD repair, the left pulmonary veins were augmented and the right upper pulmonary vein was reimplanted into the left atrium.

 

View larger version (130K): [in this window] [in a new window] [Download PPT slide]   Figure 3d.  Aortic coarctation in a 3-week-old girl with an atrioventricular septum defect (AVSD). Pulmonary vein anomalies were suspected at echocardiography. (a) Horizontal long-axis cine image shows the AVSD (**). LV = left ventricle, RV = right ventricle. (b–d) Posterior VR (b, c) and anterior subvolume MIP (d) MR angiographic images show a patent ductus arteriosus, a hypoplastic aortic arch, and the coarctation (arrow in b). The pulmonary vein anatomy is clearly defined as a common orifice of the left pulmonary veins—which is also stenotic (arrow in c)—and an anomalous connection of the right upper pulmonary vein (* in c and d) to the superior vena cava. AO = aorta, LPA = left pulmonary artery, RA = right atrium, RPA = right pulmonary artery. On the basis of the MR imaging findings, the coarctation was first repaired, and 3 weeks later, at the time of the AVSD repair, the left pulmonary veins were augmented and the right upper pulmonary vein was reimplanted into the left atrium.

 

View larger version (111K): [in this window] [in a new window] [Download PPT slide]   Figure 4a.  Pulmonary atresia with intact ventricular septum in a 1-day-old girl. (a) Horizontal long-axis cine image shows a dilated, noncontracting right ventricle (RV) and a dilated right atrium (RA). LA = left atrium, LV = left ventricle. (See also Movie 2 at radiographics.rsnajnls.org/cgi/content/full/27/1/5/DC1.) (b, c) Posterior VR (b) and coronal oblique subvolume MIP (c) MR angiographic images demonstrate that the pulmonary arteries (LPA, RPA) are hypoplastic, confluent, and supplied by a single collateral artery (CA) from the descending aorta (AO). LA = left atrium, * = pulmonary veins. A right ventricle–pulmonary artery conduit was planned, but the patient died before surgery could be performed.

 

View larger version (147K): [in this window] [in a new window] [Download PPT slide]   Figure 4b.  Pulmonary atresia with intact ventricular septum in a 1-day-old girl. (a) Horizontal long-axis cine image shows a dilated, noncontracting right ventricle (RV) and a dilated right atrium (RA). LA = left atrium, LV = left ventricle. (See also Movie 2 at radiographics.rsnajnls.org/cgi/content/full/27/1/5/DC1.) (b, c) Posterior VR (b) and coronal oblique subvolume MIP (c) MR angiographic images demonstrate that the pulmonary arteries (LPA, RPA) are hypoplastic, confluent, and supplied by a single collateral artery (CA) from the descending aorta (AO). LA = left atrium, * = pulmonary veins. A right ventricle–pulmonary artery conduit was planned, but the patient died before surgery could be performed.

 

View larger version (143K): [in this window] [in a new window] [Download PPT slide]   Figure 4c.  Pulmonary atresia with intact ventricular septum in a 1-day-old girl. (a) Horizontal long-axis cine image shows a dilated, noncontracting right ventricle (RV) and a dilated right atrium (RA). LA = left atrium, LV = left ventricle. (See also Movie 2 at radiographics.rsnajnls.org/cgi/content/full/27/1/5/DC1.) (b, c) Posterior VR (b) and coronal oblique subvolume MIP (c) MR angiographic images demonstrate that the pulmonary arteries (LPA, RPA) are hypoplastic, confluent, and supplied by a single collateral artery (CA) from the descending aorta (AO). LA = left atrium, * = pulmonary veins. A right ventricle–pulmonary artery conduit was planned, but the patient died before surgery could be performed.

 

View larger version (146K): [in this window] [in a new window] [Download PPT slide]   Figure 5a.  Total anomalous pulmonary venous drainage in a 9-month-old girl. (a) Frontal chest radiograph shows increased pulmonary vasculature in the right lung, a finding that suggests obstruction of the right pulmonary veins. Arrow indicates the dilated superior vena cava. (b, c) Anterior (b) and posterior (c) VR MR angiographic images help confirm the asymmetric caliber of the peripheral pulmonary vessels but help exclude intrinsic obstruction of the pulmonary veins. The individual pulmonary veins (*) join together in a retrocardial venous confluence (**), which drains unobstructed into the dilated superior vena cava (arrows). The azygos vein (az) is located more laterally. (d, e) Short-axis (d) and horizontal long-axis (e) cine images show that the right ventricle (RV) and right atrium (RA) are markedly dilated and that the venous confluence (**) does not communicate with the atria. The ASD is not shown on these images. LA = left atrium, LV = left ventricle. (See also Movies 3 and 4 at radiographics.rsnajnls.org/cgi/content/full/27/1/5/DC1.)

 

View larger version (123K): [in this window] [in a new window] [Download PPT slide]   Figure 5b.  Total anomalous pulmonary venous drainage in a 9-month-old girl. (a) Frontal chest radiograph shows increased pulmonary vasculature in the right lung, a finding that suggests obstruction of the right pulmonary veins. Arrow indicates the dilated superior vena cava. (b, c) Anterior (b) and posterior (c) VR MR angiographic images help confirm the asymmetric caliber of the peripheral pulmonary vessels but help exclude intrinsic obstruction of the pulmonary veins. The individual pulmonary veins (*) join together in a retrocardial venous confluence (**), which drains unobstructed into the dilated superior vena cava (arrows). The azygos vein (az) is located more laterally. (d, e) Short-axis (d) and horizontal long-axis (e) cine images show that the right ventricle (RV) and right atrium (RA) are markedly dilated and that the venous confluence (**) does not communicate with the atria. The ASD is not shown on these images. LA = left atrium, LV = left ventricle. (See also Movies 3 and 4 at radiographics.rsnajnls.org/cgi/content/full/27/1/5/DC1.)

 

View larger version (124K): [in this window] [in a new window] [Download PPT slide]   Figure 5c.  Total anomalous pulmonary venous drainage in a 9-month-old girl. (a) Frontal chest radiograph shows increased pulmonary vasculature in the right lung, a finding that suggests obstruction of the right pulmonary veins. Arrow indicates the dilated superior vena cava. (b, c) Anterior (b) and posterior (c) VR MR angiographic images help confirm the asymmetric caliber of the peripheral pulmonary vessels but help exclude intrinsic obstruction of the pulmonary veins. The individual pulmonary veins (*) join together in a retrocardial venous confluence (**), which drains unobstructed into the dilated superior vena cava (arrows). The azygos vein (az) is located more laterally. (d, e) Short-axis (d) and horizontal long-axis (e) cine images show that the right ventricle (RV) and right atrium (RA) are markedly dilated and that the venous confluence (**) does not communicate with the atria. The ASD is not shown on these images. LA = left atrium, LV = left ventricle. (See also Movies 3 and 4 at radiographics.rsnajnls.org/cgi/content/full/27/1/5/DC1.)

 

View larger version (47K): [in this window] [in a new window] [Download PPT slide]   Figure 5d.  Total anomalous pulmonary venous drainage in a 9-month-old girl. (a) Frontal chest radiograph shows increased pulmonary vasculature in the right lung, a finding that suggests obstruction of the right pulmonary veins. Arrow indicates the dilated superior vena cava. (b, c) Anterior (b) and posterior (c) VR MR angiographic images help confirm the asymmetric caliber of the peripheral pulmonary vessels but help exclude intrinsic obstruction of the pulmonary veins. The individual pulmonary veins (*) join together in a retrocardial venous confluence (**), which drains unobstructed into the dilated superior vena cava (arrows). The azygos vein (az) is located more laterally. (d, e) Short-axis (d) and horizontal long-axis (e) cine images show that the right ventricle (RV) and right atrium (RA) are markedly dilated and that the venous confluence (**) does not communicate with the atria. The ASD is not shown on these images. LA = left atrium, LV = left ventricle. (See also Movies 3 and 4 at radiographics.rsnajnls.org/cgi/content/full/27/1/5/DC1.)

 

View larger version (117K): [in this window] [in a new window] [Download PPT slide]   Figure 5e.  Total anomalous pulmonary venous drainage in a 9-month-old girl. (a) Frontal chest radiograph shows increased pulmonary vasculature in the right lung, a finding that suggests obstruction of the right pulmonary veins. Arrow indicates the dilated superior vena cava. (b, c) Anterior (b) and posterior (c) VR MR angiographic images help confirm the asymmetric caliber of the peripheral pulmonary vessels but help exclude intrinsic obstruction of the pulmonary veins. The individual pulmonary veins (*) join together in a retrocardial venous confluence (**), which drains unobstructed into the dilated superior vena cava (arrows). The azygos vein (az) is located more laterally. (d, e) Short-axis (d) and horizontal long-axis (e) cine images show that the right ventricle (RV) and right atrium (RA) are markedly dilated and that the venous confluence (**) does not communicate with the atria. The ASD is not shown on these images. LA = left atrium, LV = left ventricle. (See also Movies 3 and 4 at radiographics.rsnajnls.org/cgi/content/full/27/1/5/DC1.)

 

View larger version (69K): [in this window] [in a new window] [Download PPT slide]   Figure 6a.  Aortic stenosis in an 11-month-old boy with hypoplastic left heart syndrome. The patient had undergone a Norwood stage I procedure and bidirectional cavopulmonary anastomosis (Norwood stage II procedure). (a) Anterior (left) and posterior (middle, right) VR MR angiographic images demonstrate patency of the bidirectional cavopulmonary anastomosis, hypoplasia of the left pulmonary artery (LPA), and restenosis of the aortic isthmus (Coa). Lt IJV = left internal jugular vein, PAs = pulmonary arteries, RPA = right pulmonary artery, Rt IJV = right internal jugular vein, SVC = superior vena cava. (b) Anterior subvolume MIP MR angiographic image and graph illustrate how flow measurements obtained perpendicular to the superior vena cava (SVC) (red line) and left pulmonary artery (LPA) (yellow line) are used to calculate the right-to-left pulmonary flow ratio. In this case, the right-to-left flow ratio was 89%:11%, a finding that indicates significantly diminished flow to the left lung. (c) Horizontal long-axis cine image shows a hypoplastic left ventricle (LV) and thickening of the left pleura (arrows), findings that are indicative of a transpleural collateral blood supply to the left lung. LA = left atrium, RA = right atrium, RV = right ventricle. (See also Movie 5 at radiographics.rsnajnls.org/cgi/content/full/27/1/5/DC1.) On the basis of the MR imaging findings, catheter-guided dilation and stent placement in the aortic stenosis and left pulmonary artery were planned.

 

View larger version (38K): [in this window] [in a new window] [Download PPT slide]   Figure 6b.  Aortic stenosis in an 11-month-old boy with hypoplastic left heart syndrome. The patient had undergone a Norwood stage I procedure and bidirectional cavopulmonary anastomosis (Norwood stage II procedure). (a) Anterior (left) and posterior (middle, right) VR MR angiographic images demonstrate patency of the bidirectional cavopulmonary anastomosis, hypoplasia of the left pulmonary artery (LPA), and restenosis of the aortic isthmus (Coa). Lt IJV = left internal jugular vein, PAs = pulmonary arteries, RPA = right pulmonary artery, Rt IJV = right internal jugular vein, SVC = superior vena cava. (b) Anterior subvolume MIP MR angiographic image and graph illustrate how flow measurements obtained perpendicular to the superior vena cava (SVC) (red line) and left pulmonary artery (LPA) (yellow line) are used to calculate the right-to-left pulmonary flow ratio. In this case, the right-to-left flow ratio was 89%:11%, a finding that indicates significantly diminished flow to the left lung. (c) Horizontal long-axis cine image shows a hypoplastic left ventricle (LV) and thickening of the left pleura (arrows), findings that are indicative of a transpleural collateral blood supply to the left lung. LA = left atrium, RA = right atrium, RV = right ventricle. (See also Movie 5 at radiographics.rsnajnls.org/cgi/content/full/27/1/5/DC1.) On the basis of the MR imaging findings, catheter-guided dilation and stent placement in the aortic stenosis and left pulmonary artery were planned.

 

View larger version (162K): [in this window] [in a new window] [Download PPT slide]   Figure 6c.  Aortic stenosis in an 11-month-old boy with hypoplastic left heart syndrome. The patient had undergone a Norwood stage I procedure and bidirectional cavopulmonary anastomosis (Norwood stage II procedure). (a) Anterior (left) and posterior (middle, right) VR MR angiographic images demonstrate patency of the bidirectional cavopulmonary anastomosis, hypoplasia of the left pulmonary artery (LPA), and restenosis of the aortic isthmus (Coa). Lt IJV = left internal jugular vein, PAs = pulmonary arteries, RPA = right pulmonary artery, Rt IJV = right internal jugular vein, SVC = superior vena cava. (b) Anterior subvolume MIP MR angiographic image and graph illustrate how flow measurements obtained perpendicular to the superior vena cava (SVC) (red line) and left pulmonary artery (LPA) (yellow line) are used to calculate the right-to-left pulmonary flow ratio. In this case, the right-to-left flow ratio was 89%:11%, a finding that indicates significantly diminished flow to the left lung. (c) Horizontal long-axis cine image shows a hypoplastic left ventricle (LV) and thickening of the left pleura (arrows), findings that are indicative of a transpleural collateral blood supply to the left lung. LA = left atrium, RA = right atrium, RV = right ventricle. (See also Movie 5 at radiographics.rsnajnls.org/cgi/content/full/27/1/5/DC1.) On the basis of the MR imaging findings, catheter-guided dilation and stent placement in the aortic stenosis and left pulmonary artery were planned.

 

View larger version (92K): [in this window] [in a new window] [Download PPT slide]   Figure 7a.  Pulmonary artery stenosis in a 9-month-old girl who had undergone repair of pulmonary atresia with VSD. MR imaging was performed for assessment of the pulmonary arteries. (a) Angulated anterior VR MR angiographic image shows severe stenosis of the left pulmonary artery (arrow). (b) Velocity-encoded phase-contrast magnitude and phase images and graph illustrate flow measurements obtained perpendicular to the pulmonary arteries (LPA [yellow], RPA [red]) showing diminished flow to the left lung and indicating that the LPA stenosis is hemodynamically significant. On the basis of the MR imaging findings, catheter-guided intervention was performed. (c, d) Cranially angulated anterior angiograms obtained before (c) and after (d) intervention help confirm the LPA stenosis (arrow in c) and demonstrate the results of dilation and stent placement.

 

View larger version (61K): [in this window] [in a new window] [Download PPT slide]   Figure 7b.  Pulmonary artery stenosis in a 9-month-old girl who had undergone repair of pulmonary atresia with VSD. MR imaging was performed for assessment of the pulmonary arteries. (a) Angulated anterior VR MR angiographic image shows severe stenosis of the left pulmonary artery (arrow). (b) Velocity-encoded phase-contrast magnitude and phase images and graph illustrate flow measurements obtained perpendicular to the pulmonary arteries (LPA [yellow], RPA [red]) showing diminished flow to the left lung and indicating that the LPA stenosis is hemodynamically significant. On the basis of the MR imaging findings, catheter-guided intervention was performed. (c, d) Cranially angulated anterior angiograms obtained before (c) and after (d) intervention help confirm the LPA stenosis (arrow in c) and demonstrate the results of dilation and stent placement.

 

View larger version (114K): [in this window] [in a new window] [Download PPT slide]   Figure 7c.  Pulmonary artery stenosis in a 9-month-old girl who had undergone repair of pulmonary atresia with VSD. MR imaging was performed for assessment of the pulmonary arteries. (a) Angulated anterior VR MR angiographic image shows severe stenosis of the left pulmonary artery (arrow). (b) Velocity-encoded phase-contrast magnitude and phase images and graph illustrate flow measurements obtained perpendicular to the pulmonary arteries (LPA [yellow], RPA [red]) showing diminished flow to the left lung and indicating that the LPA stenosis is hemodynamically significant. On the basis of the MR imaging findings, catheter-guided intervention was performed. (c, d) Cranially angulated anterior angiograms obtained before (c) and after (d) intervention help confirm the LPA stenosis (arrow in c) and demonstrate the results of dilation and stent placement.

 

View larger version (122K): [in this window] [in a new window] [Download PPT slide]   Figure 7d.  Pulmonary artery stenosis in a 9-month-old girl who had undergone repair of pulmonary atresia with VSD. MR imaging was performed for assessment of the pulmonary arteries. (a) Angulated anterior VR MR angiographic image shows severe stenosis of the left pulmonary artery (arrow). (b) Velocity-encoded phase-contrast magnitude and phase images and graph illustrate flow measurements obtained perpendicular to the pulmonary arteries (LPA [yellow], RPA [red]) showing diminished flow to the left lung and indicating that the LPA stenosis is hemodynamically significant. On the basis of the MR imaging findings, catheter-guided intervention was performed. (c, d) Cranially angulated anterior angiograms obtained before (c) and after (d) intervention help confirm the LPA stenosis (arrow in c) and demonstrate the results of dilation and stent placement.

 

View larger version (127K): [in this window] [in a new window] [Download PPT slide]   Figure 8a.  Restenosis in a 4-month-old girl who, as a neonate, had undergone reconstruction of the aorta for hypoplasia and coarctation. (a, b) Left anterior oblique VR (a) and subvolume MIP (b) MR angiographic images reveal restenosis of the aortic arch, including the origin of the left subclavian artery (arrow). On the basis of the MR angiographic findings, it was decided to perform catheter-guided dilation of the aorta and subclavian artery. (c, d) Left anterior oblique angiograms help confirm the degree of stenosis seen at MR angiography and show a good result after dilation.

 

View larger version (153K): [in this window] [in a new window] [Download PPT slide]   Figure 8b.  Restenosis in a 4-month-old girl who, as a neonate, had undergone reconstruction of the aorta for hypoplasia and coarctation. (a, b) Left anterior oblique VR (a) and subvolume MIP (b) MR angiographic images reveal restenosis of the aortic arch, including the origin of the left subclavian artery (arrow). On the basis of the MR angiographic findings, it was decided to perform catheter-guided dilation of the aorta and subclavian artery. (c, d) Left anterior oblique angiograms help confirm the degree of stenosis seen at MR angiography and show a good result after dilation.

 

View larger version (142K): [in this window] [in a new window] [Download PPT slide]   Figure 8c.  Restenosis in a 4-month-old girl who, as a neonate, had undergone reconstruction of the aorta for hypoplasia and coarctation. (a, b) Left anterior oblique VR (a) and subvolume MIP (b) MR angiographic images reveal restenosis of the aortic arch, including the origin of the left subclavian artery (arrow). On the basis of the MR angiographic findings, it was decided to perform catheter-guided dilation of the aorta and subclavian artery. (c, d) Left anterior oblique angiograms help confirm the degree of stenosis seen at MR angiography and show a good result after dilation.

 

View larger version (143K): [in this window] [in a new window] [Download PPT slide]   Figure 8d.  Restenosis in a 4-month-old girl who, as a neonate, had undergone reconstruction of the aorta for hypoplasia and coarctation. (a, b) Left anterior oblique VR (a) and subvolume MIP (b) MR angiographic images reveal restenosis of the aortic arch, including the origin of the left subclavian artery (arrow). On the basis of the MR angiographic findings, it was decided to perform catheter-guided dilation of the aorta and subclavian artery. (c, d) Left anterior oblique angiograms help confirm the degree of stenosis seen at MR angiography and show a good result after dilation.

 

View larger version (176K): [in this window] [in a new window] [Download PPT slide]   Figure 9.  Rhabdomyomas. Horizontal long-axis spin-echo T1-weighted MR image shows isointense rhabdomyomas (white *) involving the ventricular septum and the posterior wall of the left ventricle (LV). The hyperintense lesion (black *) in the wall of the right atrium (RA) is probably a lipoma. LA = left atrium, RV = right ventricle.

 

View larger version (131K): [in this window] [in a new window] [Download PPT slide]   Figure 10a.  Fibroma. Coronal spin-echo T1-weighted MR images obtained before (a) and after (b) the intravenous administration of gadolinium-based contrast material show a large fibroma involving the free wall of the right ventricle (RV) and compressing the right ventricular cavity. Compared with normal myocardium, the tumor shows increased enhancement with relative sparing of its core, findings that are considered characteristic of a fibroma. e = pericardial effusion, LV = left ventricle.

 

View larger version (134K): [in this window] [in a new window] [Download PPT slide]   Figure 10b.  Fibroma. Coronal spin-echo T1-weighted MR images obtained before (a) and after (b) the intravenous administration of gadolinium-based contrast material show a large fibroma involving the free wall of the right ventricle (RV) and compressing the right ventricular cavity. Compared with normal myocardium, the tumor shows increased enhancement with relative sparing of its core, findings that are considered characteristic of a fibroma. e = pericardial effusion, LV = left ventricle.

 

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