CT and MRI for Repaired Complex Adult Congenital Heart Diseases

Figures

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  Fig. 1. Schematic drawing illustrating sequelae after transannular patch repair in a patient with tetralogy of Fallot. RVOT aneurysm and PR (blue solid arrow) are commonly encountered. Chronic and severe PR gradually dilates the RV, which may cause leftward bowing of the interventricular septum and squash the LV. Tricuspid regurgitation (blue dotted line) may ensue secondary to RV dilatation. LV = left ventricle, PA = pulmonary artery, PR = pulmonary regurgitation, RA = right atrium, RV = right ventricle, RVOT = right ventricular outflow tract, VSD = ventricular septal defect

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  Fig. 2. A 12-year-old male with repaired tetralogy of Fallot. Cardiac CT image clearly demonstrates the patency of an LPA stent (black arrows). In contrast, the stent produces a metallic artifact (white arrow) obscuring the adjacent LPA on oblique sagittal cardiac MRI (small figure inserted in the left lower corner). LPA = left pulmonary artery

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  Fig. 3. Axial cine MRI reveals a severe artifact (white arrows) obscuring both atria in a 24-year-old male with repaired tetralogy of Fallot. The artifact is caused by a vascular coil used to occlude a major aortopulmonary collateral artery (black arrow) that is clearly seen on cardiac CT (small figure inserted in the right lower corner).

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  Fig. 4. A 24-year-old male with tetralogy of Fallot who underwent Rastelli operation. Cardiac CT performed prior to percutaneous pulmonary valve implantation reveals a focus of calcified conduit (black arrow) that is barely seen on cardiac MRI (small figure inserted in the right lower corner). In addition, the spatial relationship between the conduit and the sternum cannot be accurately evaluated on cardiac MRI due to metallic artifact (star) caused by sternal wires.

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  Fig. 5. 21-year-old male with repaired tetralogy of Fallot who underwent percutaneous pulmonary valve implantation with a Venus p valve. Cardiac CT was performed to determine position and integrity of the implanted valve. Anterior volume-rendered cardiac CT image demonstrates the spatial relationship between the implanted valve and the ascending Ao. Posterior view reveals the LCA (yellow color) in close proximity to the valve struts (blue color), but without coronary artery compression. The RCA is coded in red color. Ao = aorta, LCA = left coronary artery, RCA = right coronary artery

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  Fig. 6. A 27-year-old female with repaired tetralogy of Fallot using a transannular patch. A. Cine MRI demonstrates a regurgitant jet (blue color) below the pulmonary valve plane. B. Graph of the pulmonary arterial flow volume result of phase-contrast MRI shows antegrade flow during systole (red) and retrograde flow during diastole (blue). The calculated PR fraction was 48.7%. MPA = main pulmonary artery

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  Fig. 7. Quantitative flow analysis of the RPA and the LPA in a 10-year-old female with repaired tetralogy of Fallot. Volume-rendered MRI with superior view shows a focal stenosis (arrow) at the proximal LPA and the diffusely dilated RPA. According to the flow quantification data, net flow through the LPA (5.2 mL) was substantially smaller than that through the RPA (28.6 mL); regurgitation fraction was higher in the RPA (48.3%) than that in the LPA (28.8%). Patient subsequently underwent angioplasty for the LPA stenosis. RPA = right pulmonary artery

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  Fig. 8. A 43-year-old female with repaired tetralogy of Fallot who underwent pulmonary valve replacement. A. Four-chamber view of cardiac CT obtained from a triphasic injection protocol demonstrates homogeneous opacification on both sides of the heart. B. Short-axis volume-rendered CT image shows the segmented volumes of the RV cavity (light blue), the RV mass (blue), the LV cavity (light pink), and the LV mass (dark pink) using a three-dimensional threshold-based approach. LA = left atrium

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  Fig. 9. Late gadolinium enhancement cardiac MRI in a 29-year-old female with repaired tetralogy of Fallot reveals extensive delayed enhancement (arrows) in the RVOT.

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  Fig. 10. Schematic drawing illustrating complications after arterial switch operation in a patient with transposition of the great arteries, including stenosis of the neopulmonary segment, RPA, and LPA, and aortic root dilatation with aortic regurgitation (red arrow). Kinking of the LCA may be a late complication.

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  Fig. 11. A 12-year-old female with double outlet RV who underwent arterial switch operation. Axial (A) and coronal (B) cine MRI show a narrowing of the LPA anterior to the nAo. nAo = neoaortic segment, SVC = superior vena cava

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  Fig. 12. Quantitative pulmonary flow analysis using phase-contrast MRI in an 18-year-old male with transposition of the great arteries who underwent arterial switch operation. Axial cine MRI shows comparable size of the RPA and the LPA. According to the flow quantification data, branch PA flow is evenly distributed.