Whole-heart 3D Late Gadolinium-enhanced MR Imaging: Investigation of Optimal Scan Parameters and Clinical Usefulness

Yorimitsu, Misako; Yokoyama, Kenichi; Nitatori, Toshiaki; Yoshino, Hideaki; Isono, Sachiko; Kuhara, Shigehide

doi:10.2463/mrms.11.9

Cited by 4 publications

(12 citation statements)

References 20 publications

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“…On M‐mode echocardiography, the lesion can present as a cloud of echoes penetrating the right ventricle during diastole. Due to improved diagnostic accuracy with saline contrast echocardiography, there is now an increase in its reported frequency 51–57 . Magnetic resonance imaging is now recognized as a modality with which to delineate the arrangement of the persisting valves of the systemic venous sinus.…”

Section: Resultsmentioning

confidence: 99%

“…Magnetic resonance imaging is now recognized as a modality with which to delineate the arrangement of the persisting valves of the systemic venous sinus. It provides the gold standard for the assessment of ventricular volumes 55,56 …”

Section: Resultsmentioning

confidence: 99%

“…Division of the morphologically left atrium has been estimated to be around 0.1% to 0.4%, while the persistence of the valves of the systemic venous sinus accounts for 0.025%–0.1% of congenital heart diseases 22,29–31 . Associated congenital and acquired cardiac lesions have been reported in one‐third to three‐quarters of those with divided left atriums and in one‐half of those in whom the morphologically right atrium is divided 23–28,31–91 . Limited information is available, however, on the short‐ and long‐term outcomes of treatment for these rare conditions.…”

Section: Introductionmentioning

confidence: 99%

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Surgical management of divided atrial chambers

Sankhyan

Anderson

Chowdhury

et al. 2021

Journal of Cardiac Surgery

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Background and Aim The morphological variations when one, or both, of the atrial chambers is subdivided, are many and varied. We sought to address clinical presentations, potentially misdiagnosed cases, diagnostic modalities, surgical approaches, and outcomes of this “family” of uncommon lesions. Methods A total of 193 published investigations were synthesized. Diagnostic information was provided by clinical presentation, and multimodality imaging studies. Results Almost three‐quarters of patients with divided atrial chambers present during infancy with severe pulmonary hypertension and cardiac failure. Associated cardiac and extra‐cardiac defects are present in between half and nine‐tenths of cases. Acquired division of the left atrium has been reported after the Fontan operation, orthotopic cardiac transplantation, and complicated aortic valvar infective endocarditis. Surgery under cardiopulmonary bypass remains the definitive treatment. Balloon dilation may be considered in anatomically compatible variants in the setting of cardiac failure and pregnancy as a bridge todefinitive treatment. Overall, mortality has been cited between nil to 29%. Presentation during infancy, associated congenital anomalies, pulmonary hypertension, and surgery in the previous era, have been the reported causes of death. The operative survivors have long‐term favourable outcomes, with near normal cardiac dimensions and low risk of recurrence. While asymptomatic patients with division of the right atrium do not need treatment, surgical resection of the dividing partition under cardiopulmonary bypass is recommended in symptomatic patients with complex anatomy, the spinnaker malformation, or associated cardiac anomalies. Balloon dilation may be considered in uncomplicated patients with less obstructive lesions. Hybrid intervention and endoscopic robotic correction also have been performed. Conclusions Resection of the dividing shelf allows the survivors to regain near normal dimensions with a low risk of recurrence. We submit that an increased appreciation of the anatomic background to division of the atrial chambers will contribute to improved surgical management.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical management of divided atrial chambers

Sankhyan

Anderson

Chowdhury

et al. 2021

Journal of Cardiac Surgery

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“…Further improvements in image quality with high spatial and temporal resolution can be expected for perfusion and viability CMR in the coming years [37][38][39]. The development of robust 3D techniques will increase the speed of data acquisition, further shortening scan time.…”

Section: Future Directionsmentioning

confidence: 99%

Magnetic resonance imaging

Ferreira

Robson

Karamitsos

et al. 2015

Advanced Cardiac Imaging

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“…Furthermore, the use of 3D LGE sequence permits acquisition of entire heart data in a single scan and viewing of any desired plane of the heart by reconstruction of the acquired 3D data. 4 In summary, we described a rare case of CTD and a giant EV using TEE and cardiac MR examination, which consisted of TR-MRA, cine, and 3D LGE images for preparation of catheter ablation. The knowledge of various cardiac MR findings in the assessment of RA structures may lead to proper cardiac intervention in the necessary of CS approach.…”

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confidence: 99%

Assessment of Cor Triatriatum Dexter and Giant Eustachian Valve With Cardiac Magnetic Resonance

Hwang

2014

Circulation

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A 56-year-old man with symptomatic atrial fibrillation (AF) was referred to our arrhythmia center for pulmonary vein isolation by catheter ablation. The patient underwent routine transesophageal echocardiography (TEE) and cardiac magnetic resonance (MR) examination before the catheter ablation. The cardiac MR examination consisted of time-resolved (4-dimensional) contrast-enhanced MR angiography (TR-MRA), cine imaging with steady-state free precession, and 3-dimensional (3D) late gadolinium enhancement (3D-LGE) sequences. In assessments of cardiac function and thrombus (Figure 1), the TEE image demonstrated the nodular structure adhering to the interatrial septum of right atrium (RA). The cine image revealed a thin membrane dividing the RA into 2 chambers. The proximal and distal chambers of RA were connected to the inferior vena cava (IVC) and superior vena cava (SVC), respectively. The TR-MRA ( Figure 2) showed a strongly enhanced distal chamber of RA with restriction of contrast media distribution and an unenhanced proximal chamber RA on the multiple phases of contrast dynamics. The reformatted 3D LGE images (Figure 3) showed a thin and high septum from the eustachian valve (EV) between the IVC and coronary sinus (CS) orifices and an enlargement of IVC and hepatic vein (HV). Sequentially, a catheter-based conventional angiography (Figure 4) was performed for further evaluation of RA. The septum from the EV disrupted the catheter approach to the CS in the cardiac intervention session.The cor triatriatum dexter (CTD) is characterized by the presence of a fibromuscular membrane dividing the RA into proximal and distal chambers and is rarely found in adults. 1The EV takes the form of a thin ridge-like crescent and generally arises from the anterior rim of the IVC orifice.2 If its structure and attachment to the atrial septum are large and high enough to define the giant EV, it can give the appearance of CTD. With advanced technique, cardiac MR imaging for the RA especially has become increasingly important to provide a preprocedural roadmap for necessary intervention. TR-MRA involves rapid sequential imaging of an anatomic volume during the dynamic intravascular passage of a contrast bolus and enables the identification of complex vascular flow kinetics. 3 LGE imaging has been widely used for assessing the viability of myocardium because it permits clear visualization of myocardial fibrosis. Furthermore, the use of 3D LGE sequence permits acquisition of entire heart data in a single scan and viewing of any desired plane of the heart by reconstruction of the acquired 3D data. 4In summary, we described a rare case of CTD and a giant EV using TEE and cardiac MR examination, which consisted of TR-MRA, cine, and 3D LGE images for preparation of catheter ablation. The knowledge of various cardiac MR findings in the assessment of RA structures may lead to proper cardiac intervention in the necessary of CS approach. DisclosuresNone. References1. Ozeke O, Celik A, Basel MC. Cor triatriatum dexter and sinister appearance c...

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Whole-heart 3D Late Gadolinium-enhanced MR Imaging: Investigation of Optimal Scan Parameters and Clinical Usefulness

Cited by 4 publications

References 20 publications

Surgical management of divided atrial chambers

Surgical management of divided atrial chambers

Magnetic resonance imaging

Assessment of Cor Triatriatum Dexter and Giant Eustachian Valve With Cardiac Magnetic Resonance

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