Assessment of congenital heart disease (CHD): Is there a role for fetal magnetic resonance imaging (MRI)?

Manganaro, Lucia; Savelli, Sara; Maurizio, Marco Di; Perrone, Anna; Francioso, A.; Barbera, Laura La; Totaro, P.; Fierro, Francesca; Tomei, Alessandra; Coratella, F.; Giancotti, Antonella; Ballesio, Laura; Ventriglia, Flavia

doi:10.1016/j.ejrad.2008.06.016

Cited by 47 publications

(27 citation statements)

References 19 publications

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“…In summary, with increasingly sophisticated MRI technology, faster imaging sequences, improvements in resolution, and innovative gating algorithms, fetal cardiac MRI has the potential to complement ultrasound imaging in the evaluation of fetal visceroatrial situs, 288,290,294 cardiac structure, 286,[288][289][290][291][292] and cardiac function. 287,292 Although the clinical utility of the technology has not been well established and although it currently is used mostly as a research tool, fetal cardiac MRI is reasonable to perform in the evaluation of certain forms of fetal cardiovascular disease, including heterotaxy and systemic venous anomalies, and in the assessment of associated extracardiac malformations.…”

Section: Acquisitionmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,016

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Section: Acquisitionmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,016

543

View full text Add to dashboard Cite

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“…The visualization of these anatomical structures in this study was considerably improved compared with images obtained in prior studies [16]. Prior studies described the imaging of main cardiac outflow vessels, such as the aorta with its valve, as being difficult [16]. In contrast, even the aortic valves and the proximal part of the coronary arteries were visualized in this study by using the pulse wave triggering.…”

Section: Discussionmentioning

confidence: 76%

“…It was also possible to quantify the papillary muscle of the ventricle, particularly in the short axis view. The visualization of these anatomical structures in this study was considerably improved compared with images obtained in prior studies [16]. Prior studies described the imaging of main cardiac outflow vessels, such as the aorta with its valve, as being difficult [16].…”

Section: Discussionmentioning

confidence: 91%

“…In recent years, there has been a rapid development in cardiac MR imaging which has expanded the scope of the technique and allowed evaluation of, e.g., coronary arteries and myocardial infarctions [11][12][13][14][15]. The visualization of anomalies of the heart and the great vessels is of great importance for prenatal diagnostics; however, it is not yet practicable with MRI, although newer studies showed that it is a promising method for further assessment of the cardiovascular pathologies and may be a valuable tool in assessing associated extracardiac anomalies [16].…”

Section: Introductionmentioning

confidence: 99%

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High resolution MR imaging of the fetal heart with cardiac triggering: a feasibility study in the sheep fetus

et al. 2009

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The aim of this study was to perform fetal cardiac magnetic resonance imaging (MRI) with triggering of the fetal heart beat in utero in a sheep model. All experimental protocols were reviewed and the usage of ewes and fetuses was approved by the local animal protection authorities. Images of the hearts of six pregnant ewes were obtained by using a 1.5-T MR system (Philips Medical Systems, Best, Netherlands). The fetuses were chronically instrumented with a carotid catheter to measure the fetal heart frequency for the cardiac triggering. Pulse wave triggered, breath-hold cine-MRI with steady-state free precession (SSFP) was achieved in short axis, two-, four- and three-chamber views. The left ventricular volume and thus the function were measured from the short axis. The fetal heart frequencies ranged between 130 and 160 bpm. The mitral, tricuspid, aortic, and pulmonary valves could be clearly observed. The foramen ovale could be visualized. Myocardial contraction was shown in cine sequences. The average blood volume at the end systole was 3.4 + or - 0.2 ml (+ or - SD). The average volume at end diastole was 5.2 + or - 0.2 ml; thus the stroke volumes of the left ventricle in the systole were between 1.7 and 1.9 ml with ejection fractions of 38.6% and 39%, respectively. The pulse wave triggered cardiac MRI of the fetal heart allowed evaluation of anatomical structures and functional information. This feasibility study demonstrates the applicability of MRI for future evaluation of fetuses with complex congenital heart defects, once a noninvasive method has been developed to perform fetal cardiac triggering.

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“…Many preliminary experiments have demonstrated the feasibility of fetal cardiac MRI in the evaluation of congenital cardiovascular malformations [6][7][8][9][10]. Unlike fetal echocardiography imaging, cardiovascular magnetic resonance is relatively unaffected by maternal and fetal conditions such as obesity and oligohydramnios, which particularly impair sonographic visualization of the fetal heart [11].…”

Section: Introductionmentioning

confidence: 99%

Pattern-based approach to fetal congenital cardiovascular anomalies using the transverse aortic arch view on prenatal cardiac MRI

Dong

Zhu

2014

Pediatr Radiol

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Fetal echocardiography is the imaging modality of choice for prenatal diagnosis of congenital cardiovascular anomalies. However, echocardiography has limitations. Fetal cardiac magnetic resonance imaging (MRI) has the potential to complement US in detecting congenital cardiovascular anomalies. This article draws on our experience; it describes the transverse aortic arch view on fetal cardiac MRI and important clues on an abnormal transverse view at the level of the aortic arch to the diagnosis of fetal congenital cardiovascular anomalies.

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Assessment of congenital heart disease (CHD): Is there a role for fetal magnetic resonance imaging (MRI)?

Cited by 47 publications

References 19 publications

Diagnosis and Treatment of Fetal Cardiac Disease

Diagnosis and Treatment of Fetal Cardiac Disease

High resolution MR imaging of the fetal heart with cardiac triggering: a feasibility study in the sheep fetus

Pattern-based approach to fetal congenital cardiovascular anomalies using the transverse aortic arch view on prenatal cardiac MRI

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