Magnetic Resonance Evaluation of Coronary Anatomy, First-Pass Myocardial Perfusion and Late Gadolinium Enhancement in children and Young Adults with Acquired and Congenital Heart Disease
IntroductionCardiac magnetic resonance (CMR) has expanded its role in the diagnosis and management of congenital heart disease and acquired heart disease in children. However, there are few studies evaluating the role of cardiac magnetic resonance delineating the anatomy of coronary arteries along with assessment of first pass myocardial perfusion in children. The purpose of this study is to evaluate the extensive use of CMR for delineating coronary anatomy, evaluating first pass myocardial
... usion and late gadolinium enhancement in children with acquired and congenital heart disease.MethodsA retrospective review of 81 consecutive CMR Whole Heart T2 Prep coronary angiography studies of patients with congenital and acquired heart disease that were performed from December 2013 to May 2015. Results of first pass myocardial perfusion study (at rest and with adenosine stress) and Late Gadolinium enhancement imaging findings were also reviewed.ResultsThe median age at the time of CMR was 14 years with range of 2 months to 35 years of age with 46 male and 35 female subjects. Tetralogy of Fallot was the most common pre CMR diagnosis with almost 30% (24/81) of all subjects, followed by suspected coronary artery anomaly in 18.5% (15/81) of all subjects. First pass myocardial perfusion defects were identified in 2.5% (2/81) of subjects. Delayed myocardial enhancement study was performed in 83% (67/81) of all patients, with an abnormal result identified in 28.3% (19/67) of these subjects. The left coronary origin, proximal course and proximal branches were visualized in 94% (76/81) of the subjects. The right coronary origin and proximal course was visualized in about 89% (72/81) of subjects. We found good diagnostic quality images in 90% (73/81) of the subjects. Abnormal coronary artery origin was observed in about 9% of all subjects (7/81). Coronary aneurysmal malformations were identified in 6% of all subjects (5/81). We were unable to visualize either one of the coronary arteries in about 9% of subjects (7/81) either due to patient movement during the study, metallic artifacts or extremely fast heart rate. ConclusionsCardiac magnetic resonance imaging can reliably evaluate the coronary anatomy, first pass myocardial perfusion defect and myocardial scar in a diverse group of patients with acquired and congenital heart diseases.