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Role of spin echo and cine magnetic resonance imaging in presurgical planning of heterotaxy syndrome. Comparison with echocardiography and catheterization [see comments]

AUTHOR:  Geva T; Rokey R; Wendt RE; Vick GW 3rd
      Comment in: Circulation 1995 Feb 1;91(3):906-8
      BACKGROUND: Patients with heterotaxy syndrome frequently have
      complex congenital cardiac and noncardiac malformations requiring
      detailed diagnostic evaluation by noninvasive as well as invasive
      imaging modalities for management planning. Recent advances in
      magnetic resonance imaging (MRI) techniques allow detailed
      delineation of cardiovascular anatomy and blood flow in young
      infants with rapid heart rates. The present study was undertaken
      to prospectively evaluate the role of MRI in the presurgical
      evaluation of patients with heterotaxy syndrome. METHODS AND
      RESULTS: Between January 1 and December 31, 1992, 14 consecutive
      patients with heterotaxy syndrome and complex congenital heart
      disease were enrolled in a prospective protocol. After evaluation
      by echocardiography and cardiac catheterization, a tentative
      management plan was recorded. Subsequently, a MRI study was
      performed and surgical planning was reevaluated. MRI was found to
      be comparable to echocardiography in terms of length of
      examination and sedation requirements. Surgical planning was
      altered in four patients because MRI provided additional data not
      evident on echocardiography and catheterization. Comparison of
      diagnostic yield between echocardiography, catheterization, and
      MRI showed that MRI is superior to echocardiography and often to
      catheterization in delineation of systemic and pulmonary venous
      anatomy and their relation to mediastinal structures. When the
      anatomic and hemodynamic data obtained by echocardiography and
      MRI were considered together, cardiac catheterization data were
      necessary only to determination of pulmonary vascular resistance
      before Fontan operation. CONCLUSIONS: MRI provides excellent
      anatomic and functional information that in some patients was not
      available by echocardiography or catheterization. Combined with
      echocardiography, MRI provides the high-quality diagnostic
      information necessary for management planning in most patients
      with heterotaxy syndrome. Cardiac catheterization is indicated
      when determination of pulmonary vascular resistance is necessary
      for decision making or when an interventional procedure is
SOURCE:  Circulation 1994 Jul;90(1):348-56

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