Читать книгу Interventional Cardiology - Группа авторов - Страница 275

CMR can be used to assess cardiac structure, function, and blood flow through the heart, great vessels, cardiac shunts, and extracardiac conduits in individuals with congenital heart disease (CHD) [new Congenital consensus statement]. The lack of ionizing radiation makes CMR particularly attractive in the pediatric age group as serial follow‐up studies are usually required [80] (Figure 10.5a–c).

Phase contrast velocity mapping (PCVM) is useful in quantifying pulmonic regurgitation in patients with Tetralogy of Fallot (TOF) and in quantifying the pulmonary to systemic flow ratio (Qp/Qs) (shunt fraction) in patients with atrial and ventricular septal defects [81–83]. Accurate quantification of ventricular size and function helps in determining the appropriate time for intervention. RVOT obstruction is a common complication in TOF repair. By providing accurate information on the anatomy and size of the RVOT and pulmonary arteries, CMR plays an important role in planning for percutaneous pulmonary valve implantation [84–86].

Figure 10.4 (a) and (c) diffuse LGE in the ventricles and atria. Classic finding for cardiac amyloid, (b) and (d) Intramyocardial LGE seen in myocarditis, (e) Patchy LGE seen in the hypeertrophied interventricular septum in a patient with HOCM, (f) LVOT obstruction secondary to systolic anterior motion (SAM) of the anterior mitral valve leaflet in a patient with HOCM.

CE‐MRA is particularly helpful for the assessment of abnormalities of the great vessels such as transposition, aortic arch anomalies, vascular rings, and aortic coarctation. CMR is superior to other imaging modalities including echocardiography for combined anatomic and physiologic assessment of coarctation. It can help distinguish true from pseudocaoarctation and assess for complications of repair such as restenosis or pseudoaneurysm formation [53].