MRI for detection of anomalous pulmonary venous drainage in patients with sinus venosus atrial septal defects

Abstract

Purpose of this survey was to estimate the value of MRI for the assessment of the anatomical and functional features of sinus venosus atrial septal defect (SVD). This prospective study included 13 surgically proven cases of SVD out of 81 subjects submitted to MRI due to inconclusive transthoracic echocardiography (TTE) or suspicion of high intracardiac and/or extracardiac shunt volumes based on echocardiographic findings. MRI examination included cine SSFP sequences, contrast-enhanced 3D gradient-echo (GE) sequences for MR angiography (MRA) and phase-contrast flow-measurements. MRI revealed nine patients with a superior and four with an inferior SVD. Anomalous pulmonary venous drainage (APVD) was observed only in subjects with a superior SVD, and it was right-sided in all cases. All MRI and MRA results for the SVD patients were confirmed intraoperatively. The Correlation coefficient between MR flow measurements and cardiac catheterisation was 0.94 (P<0.0001). According to MRI the rest of the subjects (n=68) presented a secundum ASD, whereas in 18% an APVD coexisted. The latter MR outcomes concurred with the cardiac catheterisation (n=56) and operative (n=12) results. MRI provides a reliable, non-invasive method for evaluation of SVDs, APVDs and shunt quantification.

The role of cardiac MRI in the diagnosis and management of sinus venosus atrial septal defect

“…CMRI can accurately quantify ventricular volumes and the magnitude of shunting. [5] Muthurangu et al ., have noted that in certain situations, phase contrast MRI is more accurate than invasive cardiac catheterization in quantifying flow and shunt size. [6] Gadolinium enhanced MRA is a sensitive method in detecting abnormalities of pulmonary venous return and can act as a surrogate for PA pressures along with detailed flow data.…”

Missed case of sinus venosus atrial septal defect post coronary artery bypass grafting

“…We also recommend the routine use of intra-operative TEE during coronary artery bypass grafting as this has a higher sensitivity in detecting high sinus venosus ASDs compared to standard 2D Echos [4,5]. …”

Adjustment of the Surgical Plan in Repair of Congenital Heart Disease: The Power of Cross-sectional Imaging and Three-dimensional Visualization

“…This information is a crucial point in presurgical planning. The application of cardiac MRI in planning of pulmonary vein redirection in this setting has been studied previously …”