Pre-Operative Evaluation with Magnetic Resonance Imaging in Tetralogy of Fallot and Pulmonary Atresia with Ventricular Septal Defect
Kritvikrom Durongpisitkul MD*, Pairash Saiviroonporn PhD**, Jarupim Soongswang MD*, Duangmanee Laohaprasitiporn MD*, Prakul Chanthong MD*, Apichart Nana MD*
Affiliation : * Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok ** Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Background : Preoperative evaluation of patients with pulmonary atresia and ventricular septal defect (PA/
VSD) are generally done by echocardiogram and cardiac catheterization. The authors’ objective of the
present study was to compare the findings of Gadolinium (Gd) enhanced cardiac magnetic resonance
angiography (MRA) with cardiac catheterization.
Material and Method: Patients who had PA/VSD were prospectively evaluated using cardiac catheterization
and cardiac MRA. A branch of the pulmonary arteries was divided into: main pulmonary artery (MPA), left
and right branch pulmonary artery (LPA & RPA), major aortopulmonary collateral arteries (MAPCA) and
minor collaterals. Each study was interpreted blindly. The agreement of findings was compared using Kappa
statistics.
Results : There were 43 patients who received both cardiac catheterization and cardiac MRI within a 2 month
period. The average age was 13.8 + 8.4 (2-30) years old. There was an agreement among measurement of both
MPA and LPA & RPA with Kappa statistics of more than 0.8. Gd-enhanced MRA was able to identify more
branches of MAPCA when compared to cardiac catheterization.
Conclusions: The results of the present study indicate that Gd-enhanced MRA is a feasible, fast and accurate
technique for identification of all sources of pulmonary blood supply in patients with complex pulmonary
atresia. The present study was a noninvasive alternative to cardiac catheterization. Gd-enhanced MRA can
better delineate small (minor) branches of collateral.
Keywords : Cardiac magnetic resonance imaging, Tetralogy of fallot, Pulmonary atresia
