Noga Michelle,  Tham Edythe,  Punithakumar Kumaradevan

Final Pr. ID: Poster #: SCI-034

Cardiac magnetic resonance imaging (CMR) is commonly used in evaluation of patients with repaired Tetralogy of Fallot (TOF). Impaired peak strain by echocardiography in TOF has been associated with adverse clinical outcome. Assessment of myocardial deformation (strain) using novel CMR software may provide prognostic information in TOF. Because of ventricular interaction, abnormal left ventricle (LV) mechanics are seen in echocardiography speckle tracking. We aimed to determine correlates of right (RV) and LV function using LV diastolic filling analysis in patients with repaired TOF. Read More

Authors:  Noga Michelle , Tham Edythe , Punithakumar Kumaradevan

Keywords:  Cardiac, magnetic resonance imaging, Tetralogy of Fallot

Southard Richard,  Ellsworth Erik,  Moe Tabitha,  Augustyn Robyn,  Thorkelson Marrit,  Bardo Dianna

Final Pr. ID: Poster #: EDU-090

The structure of the heart is more complex than 4 major chambers, 4 major valves, venous inflow and arterial outflow.

Muscular and soft tissue ridges, perforated membranes, tissue flaps, electrical pathways, external grooves, endocardial surface characteristics, and a core architecture structured of fibrous tissue and embryonic tissue remnants form distinguishing anatomic landmarks. These structures provide insight into cardiac development, serve physiologic purpose, define structural and functional elements, as well as offer prognostic information.

Specific details of cardiac anatomy may not be recognized on cardiac MR and CT examinations. Structural anomalies that affect cardiac function and anatomic or physiologic relationships may be abnormal in hearts with congenital malformations. The fine structural details of the heart are typically not part of an imagers search pattern and are therefore overlooked or underreported. Each minute structure and anatomic characteristic provides clues to errors in cardiac formation and may provide clinically relevant diagnostic information. After palliation of CHD defining anatomic structure may be lost, displaced, interrupted or even restored.

Important processes, corresponding anatomic landmarks, and effects of malformation in defining congenital heart disease anatomy, physiology and functional variation from normal include basal structures such as the central fibrous body of the heart, atrial structures including the crista terminalis, the sinus venarum, and eustacian valve, and ventricular structures such as the crista supraventricularis.

Each structure is described along with its normal location, anatomy functional and physiologic importance, the effect of congenital malformation, and imaging findings as in the example of the central fibrous body (table 1).

Minute cardiac anatomy will be shown in illustration as well as in CT and MR images (figure 1). Read More

Authors:  Southard Richard , Ellsworth Erik , Moe Tabitha , Augustyn Robyn , Thorkelson Marrit , Bardo Dianna

Keywords:  Cardiac anatomy, Cardiac MR, Cardiac CT, Congenital heart disease, Embryology

Bhargava Ravi,  Anderson Scott,  Chari Radha

Final Pr. ID: Poster #: SCI-019

Fetal demise (FD) occurs in 1/1000 pregnancies after 20 weeks gestation. MRI is increasingly being used after ultrasound to assess fetal pathology. FD may occur in the interval between ultrasound and MRI, and various organ systems have been described as having changes on fetal MRI. Although ultrasound findings of FD have been well described, criteria for FD on MRI have not. Diffusion MRI evaluates Na⁺/K⁺ channel viability and can be used to evaluate tissue death. Flowing blood produces signal loss on MRI, and along with fetal heart activity results in MRI signal loss of the cardiac chambers. FD with no heart motion and increased signal within non-flowing blood in the heart should result in increased signal in the chambers relative to the myocardium. Either of these findings can be seen with different fetal pathology, but the combination of brain and cardiac changes may allow for a diagnosis of FD. We hypothesize that restricted brain diffusion in certain brain lobes along with increased signal within heart chambers is specific for FD. Read More

Authors:  Bhargava Ravi , Anderson Scott , Chari Radha

Keywords:  Fetal MRI, Brain, Cardiac

Dennison Chelsea,  Taylor Susan,  Wilson Hunter,  Slesnick Timothy,  Riedesel Erica

Final Pr. ID: Poster #: EDU-005

Over the last twenty years there has been a rapid expansion in the vast array of implantable cardiac devices utilized in pediatric patients. Imaging plays a key role in the management of patients with these devices. It is important for the pediatric radiologist to recognize the specific type of cardiac device visualized on radiographic images in order to make an accurate assessment of the appropriate position and any potential complications. With new cardiac devices entering the market it can be very perplexing and daunting for the radiologist to stay familiar with them all.

We will seek to review old and new pediatric cardiac devices currently used at our institution and their radiographic appearance.

These devices will be divided into categories of pacing devices, prosthetic heart valves, stents, closure devices, ventricular assist devices, extracorporeal membrane oxygenation systems (ECMO), and external monitoring devices.

Pacing devices: a) Epicardial and transvenous pacing systems b) Leadless pacemakers
Prosthetic heart valves: a) Surgically implanted valves b) Transcatheter valves
Cardiac stents
Closure devices: a) Patent ductus arteriosus closure device, b) Atrial septal defect closure device c) Vascular plugs and coils
Ventricular assist devices: a) Left ventricular assist device, b) Right ventricular assist device, c) Bi-ventricular assist device
Extracorporeal membrane oxygenation (ECMO) cannulas: a) Venous-arterial ECMO, b) Venous-venous ECMO
External monitoring devices: a) Holter monitor, b) Loop recorder Read More

Authors:  Dennison Chelsea , Taylor Susan , Wilson Hunter , Slesnick Timothy , Riedesel Erica

Keywords:  Cardiac Devices, Radiograph

De Leon-benedetti Laura,  Ramirez Suarez Karen,  Otero Hansel,  Rapp Jordan,  Biko David,  Smith Christopher,  Serai Suraj,  White Ammie

Final Pr. ID: Poster #: EDU-003

Magnetic resonance imaging (MRI) has historically been restricted for patients with pacemakers, defibrillators, or other cardiac implantable electronic devices (CIEDs) due to safety concerns. Despite the introduction of MR conditional pacemakers in 2008, access to MRI in patients with CIEDS remains limited.
MRI remains the diagnostic imaging study of choice for many indications and is necessary to prevent delayed diagnosis and the decision to proceed with MRI should follow a rigorous risk benefit assessment:
Risks of:
Lead heating causing injury at their tips
Increased pacing thresholds
Sudden battery depletion
Inappropriate sensing/pacing
The location of the image should be considered because if the request includes the area of the CIED then potential artifacts may decrease the diagnostic quality. However, an MRI remote from the location of the CIED entails a negligible risk of lead heating and MRI may be performed safely with continuous patient monitoring throughout the scan. In addition, in pediatric patients the necessity of anesthesia or sedation must be well-thought-out as it conveys additional risk to the patient.
There is growing evidence from adult literature that MRI may be performed safely in patients with CIEDs with transvenous leads when appropriate protocols are followed. The Heart Rhythm Society (HRS) 2017 expert consensus statement indicates that MRI is reasonable in patients with MR non-conditional transvenous CIEDs if there are no fractured, epicardial, or abandoned leads. The Pediatric and Congenital Electrophysiology Society (PACES) of 2021 included that MRI may be considered in pediatric patients with epicardial or abandoned leads on a case-by-case basis. However, performing MRI in patients with CIEDs is a resource-intensive service and requires rigorous implant investigation, preparation, and planning as well as close coordination between treating physicians and radiologist.
This educational exhibit summarizes current literature on the safety of MRI in patients with CIEDs and takes examples from our practice to build an evaluation program that allows for safe access to MRI in patients with CIEDs Read More

Authors:  De Leon-benedetti Laura , Ramirez Suarez Karen , Otero Hansel , Rapp Jordan , Biko David , Smith Christopher , Serai Suraj , White Ammie

Keywords:  Cardiac, Magnetic Resonance

Navallas Maria,  Zuccarino Flavio,  Inarejos Clemente Emilio J,  Marie Eman,  Gerrie Samantha,  Ladera Gonzalez Enrique,  Barber De La Torre Ignasi

Final Pr. ID: Poster #: EDU-010

Learning objectives:
1.Review the main pediatric cardiomyopathy phenotypes.
2.Clarify the role of MRI across the care pathway.
3.Walk through the key MRI sequences we actually use in kids.
4.Recognize the essential imaging findings that help us differentiate among them.

- Introduction:
Pediatric cardiomyopathies are a rare heterogeneous group of myocardial diseases but are the first cause of heart transplantation in children.
Causes are diverse—genetic mutations, coronary anomalies, infections, toxins, arrhythmias—and sorting out phenotypes can be tricky because adult criteria are often not applicable to kids and because many kids don’t tolerate long exams.

- Imaging techniques:
Echocardiography represents the first first-line modality but it is often complemented with CMR as it allows a radiation-free differentiation between different phenotypes with unique myocardial tissue characterization, playing a key role in diagnosis, risk stratification, and treatment assessment.

- Key MRI sequences:
Conventional cardiomyopathies protocols in children may use 1.5 or 3 Tesla field strengths and include the following sequences:
Initial localizers.
Cine imaging.
Phase contrast.
Parametric mapping.
LGE.

- Dilated Cardiomyopathy:
Most common.
Leading cause of heart transplant.
Dilated chambers.
Reduced systolic function.
LGE: Patchy or longitudinal mid-wall, transmural, subepicardial, or diffuse subendocardial involvement. Presence of LGE indicates poor prognosis and increased risk of SCD.
Native T1 mapping is suggested to be the strongest independent predictor of diffuse myocardial disease, allowing for the identification of patients at risk for adverse outcomes.

- Hypertrophic Cardiomyopathy:
2nd most common.
LV hypertrophy z-score >2.5 (no family history) or >2 (with family history/genetic test).
LVOT obstruction and SAM.
LGE: Independent risk factor for SCD.
Differential diagnosis with athlete's heart.

- Arrhythmogenic Cardiomyopathy:
RV and/or LV dilatation and reduced EF.
Wall motion abnormalities – most important finding in kids.
Myocardial fibrosis.
Fatty infiltration rare in children.

- Restrictive Cardiomyopathy:
Rarest CMP.
Non-dilated biventricular failure and biatrial dilatation.
Ddx: constrictive pericarditis.

- Excessive trabeculation/NCCM:
Non-compacted/Compacted myocardium ratio > 2.3 measured in diastole.
In the absence of dilation or systolic dysfunction, can be considered a phenotypic trait not necessarily associated with CMP. Read More

Authors:  Navallas Maria , Zuccarino Flavio , Inarejos Clemente Emilio J , Marie Eman , Gerrie Samantha , Ladera Gonzalez Enrique , Barber De La Torre Ignasi

Keywords:  Cardiomyopathy, Cardiac MRI

Calderon Kylie,  Robinson Joshua,  Husain Nazia,  Popescu Andrada,  Rigsby Cynthia

Final Pr. ID: Poster #: SCI-007

Coronary artery abnormalities are a serious complication following the arterial switch operation (ASO) for d-transposition of the great arteries (TGA). While CTA optimally visualizes the coronaries, prior studies have found potentially high-risk coronary lesions in asymptomatic s/p ASO patients, raising questions about when CTA is warranted. CMR is commonly used for monitoring after the ASO, offering assessment without radiation. However, its utility for coronary evaluation remains unclear. We aimed to (1) compare the indications and outcomes of CMR vs. CTA after ASO, and (2) compare coronary features between modalities. Read More

Authors:  Calderon Kylie , Robinson Joshua , Husain Nazia , Popescu Andrada , Rigsby Cynthia

Keywords:  Cardiac MRI, Congenital Heart Disease, Computed Tomographic Angiography

Ordonez Alvaro,  Stecher Priscilla,  Rogers Lindsay,  Bhatti Tricia,  Noor Abass

Final Pr. ID: Poster #: CR-006

Single ventricle heart defects (SVHD) refer to a rare and diverse group of severe congenital cardiac abnormalities in which the systemic and pulmonary venous return enter a functionally single ventricular chamber. This condition is typically caused by underdevelopment of an atrioventricular valve and/or a ventricular chamber, leading to a range of complex congenital heart defects. With an incidence of approximately 3 to 5 per 10,000 live births, newborns with SVHD are critically ill, and without medical intervention, the condition is fatal. Advancements in surgical techniques, namely staged palliation and orthotopic heart transplantation, have enabled more patients with SVHD to survive into adulthood. However, despite these improvements, the perinatal period remains tenuous.

We present a five-week-old male infant born at 38 weeks of gestation with a functional SVHD in the form of severe subaortic stenosis, arcade-like mitral valve, left ventricular dilation and dysfunction, and restrictive atrial septum. He received multiple surgical interventions, including atrial septal stenting with pulmonary artery banding and stage I reconstruction with a right Blalock-Thomas-Taussig shunt. Postoperative course was complicated by delayed sternal closure, cardiac arrest, right hemidiaphragm plication, and progressive heart failure. At five weeks, CT angiography showed a functional single ventricle status post Damus-Kaye-Stansel anastomosis, hypoperfusion of the left ventricle myocardium, and pneumoperitoneum. Exploratory laparotomy with segmental bowel resection revealed perforated acute appendicitis and mucosal ulceration of the cecum. Following the procedure, he developed acute hypoxemia and bradycardia. Life-sustaining support was withdrawn. Postmortem examination of the heart was notable for severe aortic stenosis with subaortic obstruction, stenotic mitral valve with arcade-like fibrous plaques, and biventricular hypertrophy. Histopathology of the left ventricle showed significant subendocardial fibrosis without areas of myocyte injury.

Due to the complexities involved in its management, SVHD demands special attention from radiologists. While advancements in medical and surgical care have improved outcomes, ongoing progress depends on a deeper understanding of the factors contributing to ventricular dysfunction and heart failure in this vulnerable population. Read More

Authors:  Ordonez Alvaro , Stecher Priscilla , Rogers Lindsay , Bhatti Tricia , Noor Abass

Keywords:  Ventricular Dysfunction, Cardiac CTA, Cardiovascular Disease

Ugas Charcape Carlos,  Cerron Vela Carmen

Final Pr. ID: Paper #: 016

To characterize the range of cardiac and extracardiac CT findings in children with thoracic ectopia cordis in the setting of Cantrell syndrome.
Read More

Authors:  Ugas Charcape Carlos , Cerron Vela Carmen

Keywords:  Pentalogy Of Cantrell, Cardiac, Malformation

Priya Sarv,  Narayanasamy Sabarish,  Nagpal Prashant

Final Pr. ID: Poster #: CR-002

Left ventricular diverticulum is an uncommon congenital malformation defined as a localized, contractile outpouching of the ventricular wall. It must be carefully distinguished from acquired ventricular aneurysm or pseudoaneurysm, as the diagnostic implications, management strategies, and long-term prognosis differ substantially.

A 2-month-old infant was referred for advanced imaging after transthoracic echocardiography raised concern for an abnormal left ventricular contour. Cardiac CT and MRI confirmed a discrete outpouching along the basal to mid anterolateral wall, measuring approximately 2.1 cm in maximal diameter, with a neck dimension of 13–14 mm. Myocardium was clearly present overlying the outpouching, and the structure demonstrated preserved systolic contractility synchronous with the adjacent ventricular wall. No evidence of wall thinning, akinesia, dyskinesia, or delayed gadolinium enhancement was identified. Global biventricular function was preserved, and coronary anatomy was normal.
The initial impression suggested a basal anterolateral LV aneurysm; however, the morphological and functional features, including intact myocardial layers and preserved contraction, were more consistent with a congenital LV diverticulum. Importantly, the absence of clinical history of ischemic, inflammatory, or traumatic insult supported this conclusion.
The key differential diagnoses include congenital LV diverticulum, true aneurysm, and pseudoaneurysm. Congenital diverticula are contractile and narrow-necked, maintaining myocardial continuity. True aneurysms typically follow myocardial infarction or myocarditis and demonstrate dyskinesia and wall thinning. Pseudoaneurysms result from contained rupture, are characterized by absent myocardial continuity, and frequently have a wide neck. Careful assessment of wall, contractility, and enhancement characteristics are essential for accurate classification.
On follow-up echocardiogram imaging, the diverticulum remained stable in morphology and size, without evidence of thrombus formation or functional deterioration. Conservative management with periodic surveillance was advised.
This case underscores the importance of multimodality imaging in ventricular outpouchings, demonstrating how contractile morphology and myocardial integrity support the diagnosis of congenital LV diverticulum. Precise differentiation from acquired lesions prevents misclassification, informs prognosis, and guides appropriate long-term management. Read More

Authors:  Priya Sarv , Narayanasamy Sabarish , Nagpal Prashant

Keywords:  Cardiac CTA, Cardiovascular, Congenital

Bee Stella,  Woon Tian Kai,  Yap Kok Hooi,  Fortier Marielle

Final Pr. ID: Poster #: EDU-004

In congenital heart disease (CHD), CT cardiac angiography (CTCA) has an important role in surgical planning and evaluating post-surgical complications, complementing echocardiography and cardiac magnetic resonance imaging (cMRI). Its strengths are in its high spatial resolution, rapid acquisition, and excellent 3D reconstruction capabilities for visualization of complex vascular and intracardiac relationships. However, unless radiologists tailor reconstructions and reports to address the surgeons’ needs, its full potential is underutilized. To do this, radiologists need to be aware of at least broad strokes of cardiac pathophysiology, as well as modern surgical approaches and potential post-surgical complications, for the most common CHDs. This will ensure that the utility of CTCA reports transcend volumetric and vascular measurements, and instead, anticipate technical challenges, identify hidden hazards, shape surgical strategy and pick up specific post-surgical complications.
We propose structured CTCA reporting framework for CHD centred on the needs of the surgeon, by prioritising specific information surgeons find most useful across various CHD conditions. The objectives of this poster are a) to review, by consensus with paediatric cardiac surgeons, the key imaging features in CTCA based on different CHD lesions. b) To propose a reporting checklist for CTCA that emphasizes those key features. c) To demonstrate application of this surgeon centric framework via illustrative cases, focusing on the tetralogy of Fallot, transposition of great arteries, total or partial anomalous pulmonary venous return, and coarctation of the aorta. Read More

Authors:  Bee Stella , Woon Tian Kai , Yap Kok Hooi , Fortier Marielle

Keywords:  Cardiac CTA, Reporting, Congenital Heart Disease

Bardo Dianna,  Lindblade Christopher,  Wishah Fidaa,  Patel Mittun,  Cornejo Patricia,  Ellsworth Erik,  Awerbach Jordan,  Goncalves Luis

Final Pr. ID: Paper #: 100

Purpose is to describe how FCMR is instrumental in diagnosis of congenital heart disease (CHD) and to present imaging findings and correlation in 50 fetuses with CHD. Read More

Authors:  Bardo Dianna , Lindblade Christopher , Wishah Fidaa , Patel Mittun , Cornejo Patricia , Ellsworth Erik , Awerbach Jordan , Goncalves Luis

Keywords:  fetal cardiac MRI, congenital heart disease

Bardo Dianna,  Lindblade Christopher,  Wishah Fidaa,  Cornejo Patricia,  Patel Mittun,  Ellsworth Erik,  Awerbach Jordan,  Goncalves Luis

Final Pr. ID: Poster #: EDU-006

The purpose of this educational exhibit is to show FCMR images of congenital heart disease (CHD) and anatomical findings associated with CHD. We will describe currently available FCMR image acquisition techniques and use a case-based approach to show a variety of CHD diagnosis with teaching points to highlight the added value of FCMR in diagnosis and prognosis. Read More

Authors:  Bardo Dianna , Lindblade Christopher , Wishah Fidaa , Cornejo Patricia , Patel Mittun , Ellsworth Erik , Awerbach Jordan , Goncalves Luis

Keywords:  Fetal cardiac MRI, congenital heart disease

Goncalves Luis,  Lindblade Christopher,  Cornejo Patricia,  Patel Mittun,  Wishah Fidaa,  Bardo Dianna

Final Pr. ID: Paper #: 107

The purpose of this study is to report visualization rates for standard cardiac axial views by FCMR using a prospective ECG pseudogating method and compare visualization rates for acquisitions performed in 1.5 and 3T. Secondary aims include a comparison of image quality between 2 observers and between 1.5 and 3T. Specific absorption rates (SAR) are also compared. Read More

Authors:  Goncalves Luis , Lindblade Christopher , Cornejo Patricia , Patel Mittun , Wishah Fidaa , Bardo Dianna

Keywords:  fetal cardiac MRI, 3T, image quality

Dong Su-zhen

Final Pr. ID: Poster #: EDU-010

1. Review the safety, limitations and advantages of fetal cardiac MR (CMR)
2. Discuss potentialindications of fetal CMR
3. Describe the technique of fetal CMR, including imaging sequences, imaging planes, the method
of overcoming motion artifact
4. Illustrate the appearance of normal fetal cardiac structures and present a modified anatomic
segmental approach of congenital heart disease (CHD) at prenatal CMR
5. Demonstrate examples of fetal CMR in the evaluation of various cardiovascular anomalies Read More

Authors:  Dong Su-zhen

Keywords:  Fetus, cardiac magnetic resonance, congenital heart disease

Fuentealba Cargill Andrea,  Friesen Richard,  Fujiwara Takashi,  Park Sungho,  Arguello Fletes Gladys,  Englund Erin,  Barker Alex,  Londono Obregon Camila,  Browne Lorna

Final Pr. ID: Poster #: CR-015

A 29-year-old female (G6P4) was referred to our center following identification of thoracoomphalopagus conjoined twins, with fused heart and liver, at 20 weeks of gestation. Fetal echocardiogram and fetal cardiac MR (CMR) were performed at 21 weeks gestation to evaluate potential for post-natal repair.
Fetal CMR was performed at 1.5 Tesla using an MRI compatible fetal doppler ultrasound (DUS) device (smart-sync, Northh imaging) for cardiac gating. Protocol included multiplanar cine SSFP sequences and multiplanar blackblood sequences.
Fetal echocardiography and CMR were used together to understand the complex anatomical arrangements. Each twin had 2 sets of atria (with an interatrial connection) but only a single ventricle. Twin A had a left ventricle, pulmonary atresia and MAPCAs. Twin B had a right ventricle had coarctation of the aorta, bilateral SVCs and partial anomalous pulmonary venous return. After counselling regarding the grave prognosis of both twins, the patient decided to deliver at her local hospital with comfort care.
Teaching Points from this Case
This case of conjoined twins at 21 weeks gestation, is the youngest example of successful clinical DUS fetal CMR. In this case, fetal CMR was used to demonstrate the great vessel anatomy and was fundamental in ascertaining the absence of a path to successful surgical palliation for either twin. Additionally, fetal CMR was used as the primary modality during patient counselling to explain the anomalies. The high degree of diagnostic certainty that the fetal CMR facilitated, allowed the family to avoid the unnecessary emotional and financial expense that relocation for delivery would have incurred and facilitated palliative care at their local center. Read More

Authors:  Fuentealba Cargill Andrea , Friesen Richard , Fujiwara Takashi , Park Sungho , Arguello Fletes Gladys , Englund Erin , Barker Alex , Londono Obregon Camila , Browne Lorna

Keywords:  Fetal MRI, Cardiac MRI, 4D Flow

Fuentealba Cargill Andrea,  Friesen Richard,  Barker Alex,  Fujiwara Takashi,  Englund Erin,  Park Sungho,  Londono Obregon Camila,  Browne Lorna

Final Pr. ID: Poster #: CR-012

A 22-year-old G2P1 female presented to our institution at 22 weeks for fetal cardiology evaluation of hypoplastic left heart syndrome (HLHS) with mitral stenosis and aortic atresia. Fetal echocardiogram confirmed the diagnosis and suggested a severely restricted atrial septum with a pulmonary venous forward/reverse time-velocity integral ratio (VTI) of 2.7.
At 29 weeks' gestation, she underwent a fetal CMR to evaluate for pulmonary lymphangiectasia and interatrial septum.
Fetal cardiac gating was obtained with an MR-compatible Doppler ultrasound device (Smartsync, Northh Medical) and imaging was performed at 3T.
In addition to the findings of HLHS, findings at fetal CMR included an intact/severely restrictive atrial septum with markedly dilated pulmonary veins. Additionally, there was an anomalous pulmonary vein connecting the right sided pulmonary veins to both the azygos vein and the SVC. 4D flow MRI quantified the distribution of blood flow, demonstrated a similar pulmonary venous forward/reverse flow ratio of 2.4 and visualized the anomalous vessel decompressing the pulmonary venous system into the systemic venous system. There was a segmental pattern of pulmonary lymphangiectasia, present in the right middle lobe and lingula.
Same day fetal echocardiography also confirmed the anatomical findings. The patient was determined not to be a candidate for fetal intervention and following counselling, the family elected for comfort care at delivery. After delivery, the baby did not demonstrate clinical signs of a restrictive atrial septum, despite an atrial septal gradient of 11mmHg by echocardiography, and following re-evaluation, underwent a staged single ventricle palliation. At surgery for stage 1 (Norwood-Sano), the atrial septum was found to be almost intact. The infant continues to do well and currently is status post stage 2 with a superior cavopulmonary anastomosis.
This case demonstrates the use of fetal CMR with an MR compatible doppler ultrasound device in the fetal evaluation of HLHS with a suspected restrictive atrial septum. In this case, fetal CMR with 4D flow was able to calculate a pulmonary venous forward/reverse flow ratio similar to echocardiography and demonstrated the anomalous pulmonary venous drainage pathway, which likely accounted for the absence of the expected severe manifestations of an intact atrial septum in addition to the relatively mild manifestations of pulmonary lymphangiectasia. Read More

Authors:  Fuentealba Cargill Andrea , Friesen Richard , Barker Alex , Fujiwara Takashi , Englund Erin , Park Sungho , Londono Obregon Camila , Browne Lorna

Keywords:  4D Flow, Pulmonary Venous Return, Cardiac MRI

Zucker Evan,  Sandino Christopher,  Kino Aya,  Lai Peng,  Vasanawala Shreyas

Final Pr. ID: Paper #: 014

To assess the image quality and clinical performance of a novel accelerated, free-breathing 2D cine cardiac MR sequence with DCNN reconstruction in comparison to conventional breath-held 2D cine balanced steady-state free precession (bSSFP). Read More

Authors:  Zucker Evan , Sandino Christopher , Kino Aya , Lai Peng , Vasanawala Shreyas

Keywords:  Cardiac, MRI, Deep Learning

Rathore Bhagyashree,  Wang Harris,  Miles Kimberley,  Berklite Lara,  Schneider Kristin,  Morin Cara

Final Pr. ID: Poster #: EDU-005

Teaching Points:
1. Review the imaging approach and differential diagnosis for cardiac masses in children
2. Illustrate the characteristic imaging findings of benign and malignant pediatric cardiac tumors and understand the spectrum of pseudotumors that may be encountered in pediatric cardiac disease.
3. Discuss the screening guidelines and management approach to cardiac masses in children with predisposition syndromes.
4. Review radiologic-pathologic correlation for cardiac masses and pseudomasses in children.

Outline:
1. Review our institutional experience, including the relative frequency of cardiac masses and pseudomasses
2. Describe the recommended imaging protocols for screening, surveillance, and characterization of cardiac masses on echocardiography, CT, and MRI
3. Describe the imaging findings at echocardiography, CT, and MRI in the spectrum of pediatric cardiac tumors and pseudotumors in:
a. Predisposition syndromes: Tuberous sclerosis, Nevoid basal cell carcinoma syndrome, Carney complex, etc.
b. Primary malignant cardiac tumors: Rhabdomyosarcoma, angiosarcoma, malignant fibrous histiocytoma, fibrosarcoma, etc.
c. Secondary cardiac tumors: Osteosarcoma, hepatoblastoma, neuroblastoma, Ewing sarcoma, synovial cell sarcoma, etc.
d. Benign cardiac masses: Mature teratoma, vascular malformations, lipoma, myxoma, fibroma, etc.
e. Cardiac pseudomasses and mimics: Thrombus, Epicardial/myocardial fat necrosis, pseudoaneurysms, granulomatous disease, etc.
4. Provide radiologic-pathologic correlation for cardiac masses and pseudomasses in children Read More

Authors:  Rathore Bhagyashree , Wang Harris , Miles Kimberley , Berklite Lara , Schneider Kristin , Morin Cara

Keywords:  cardiac, oncology, pseudomasses

O'donohue Laura,  Balasubramanian Sowmya,  Mody Swati,  Agarwal Prachi,  Dorfman Adam,  Lu Jimmy,  Joshi Aparna

Final Pr. ID: Poster #: EDU-008

With increased use of CT and MR for coronary imaging in children, pediatric radiologists are more likely to encounter the unusual finding of dilated or aneurysmal coronary arteries. An understanding of the differential diagnoses and clinical associations is critical for accurate diagnosis and timely initiation of therapy. This educational exhibit begins with a discussion of diagnostic criteria and terminology for describing coronary dilation. The exhibit includes representative cases of the various causes of coronary artery dilation and aneurysms in children, including congenital abnormalities (coronary artery fistula, ALCAPA, ARCAPA), acute infection/inflammation (Kawasaki Disease, MIS-C), chronic immune-mediated disorders (Takayasu arteritis, polyarteritis nodosa), connective tissue diseases, and iatrogenic/acquired etiologies. Implications for surgical/interventional planning, particularly for congenital etiologies, are a key attribute of cross-sectional imaging. Imaging characteristics and clinical manifestations are discussed in the context of each case. Read More

Authors:  O'donohue Laura , Balasubramanian Sowmya , Mody Swati , Agarwal Prachi , Dorfman Adam , Lu Jimmy , Joshi Aparna

Keywords:  Aneurysm, Coronary Artery, Cardiac

Griffin Lindsay,  Francois Christopher

Final Pr. ID: Poster #: EDU-003

The purpose of this educational presentation is to review the feed and wrap method, also known as feed and sleep, swaddle, or bundle, as an alternative to deep sedation or general anesthesia through a pictorial review of cardiac magnetic resonance (MR) studies performed using this method. The feed and wrap technique in which feeding and warmth are used to induce sleep and swaddling is used to reduce motion is described. Indications and contraindications as well risks and benefits of this method versus general anesthesia and deep sedation are discussed. Multiple examples of congenital heart disease including atrial and ventricular septal defects, atrioventricular canal defects, and double outlet right ventricle are provided, with sequences used, length of scan, and diagnostic quality also summarized. The example shown in Figures 1-3 is a 12-day-old female. The scan was completed in 12 minutes without intravenous contrast. Figure 1 is the scout image showing situs inversus. Figure 2 is a gated axial steady state free procession (SSFP) image showing a membranous ventricular septal defect (yellow arrow), an atrial septal defect (yellow arrowhead), and atrial inversion. Figure 3 is a 4D flow reconstruction showing the superior and inferior vena cava entering anatomic right atrium on the left, a right aortic arch with mirror branch pattern, and relationship to the main pulmonary artery (MPA). Read More

Authors:  Griffin Lindsay , Francois Christopher

Keywords:  Cardiac, Anesthesia, Alternative

Priya Sarv,  Narayanasamy Sabarish,  Nagpal Prashant

Final Pr. ID: Poster #: CR-004

Transposition of the great arteries (TGA) is typically described using the prefixes “D” and “L,” based on the position of the aortic root relative to the pulmonary trunk. In current practice, these prefixes are often applied as shorthand to define specific segmental combinations, such as “D-TGA” for concordant atrioventricular and discordant ventriculo-arterial connections, or “L-TGA” for congenitally corrected variants. However, atypical and mirror-image cases challenge the accuracy of this prefix-based terminology and highlight the need for full segmental description.

A 4-year-old boy with a background of complex congenital heart disease presented for follow-up evaluation prior to surgical intervention. He had a known history of mirror-imaged visceral arrangement and had previously undergone a bidirectional Glenn shunt for palliation of pulmonary atresia, ventricular septal defect, and atrial septal defect. Cardiac computed tomography revealed mirror-imaged atrial arrangement, with the morphologic right atrium located on the left and the morphologic left atrium on the right. The thoraco-abdominal organs were similarly reversed, including a left-sided liver and right-sided stomach and spleen. The ventricles showed D-looping with right-handed topology, with the morphologic right ventricle on the right and morphologic left ventricle on the left. The aorta arose discordantly in a rightward and anterior position relative to the pulmonary trunk, consistent with transposition physiology in this mirror-image setting.
This case demonstrates the limitations of relying solely on “D” and “L” prefixes. In this patient, the aortic root position was consistent with “D-TGA” in its original spatial sense, yet the overall physiology was that of congenitally corrected transposition due to the underlying atrioventricular and ventriculo-arterial connections. Describing the case simply as “D-TGA” would be misleading and risk miscommunication in clinical and surgical planning.
This report emphasizes that accurate diagnosis and classification of TGA require comprehensive segmental analysis, including atrial arrangement, ventricular topology, and the nature of atrioventricular and ventriculo-arterial connections. The position of the aorta should be reported separately rather than equated with transposition type. Recognition of these principles is essential to avoid confusion and ensure clarity in the management of complex and mirror-image variants of congenital heart disease. Read More

Authors:  Priya Sarv , Narayanasamy Sabarish , Nagpal Prashant

Keywords:  Cardiac CTA, Complex Congenital Heart Disease, Cardiovascular

Henault Kathryn,  Upadhyay Shailendra,  Herbst Timothy,  O'loughlin Michael,  Toro-salazar Olga

Final Pr. ID: Poster #: EDU-004

CHD (congenital heart disease) occurs in approximately 1% of all live births with more than 90% survival into adulthood. Prevalence of coronary artery disease has been reported to be similar to general adult population. Patients with complex CHD may be subjected to non-atherosclerotic premature coronary artery disease due to anomalous coronaries, peri-coronary region interventions, or coronary re-implantation. Cardiac MRI (CMR) may provide valuable myocardium health information with pointers towards a coronary distribution in unsuspected chronic or acute cases. Acquisition of delayed enhancement sequences (LGE) and T1 mapping should be considered routine in CMR studies for assessment of interval ischemic events. Patients with complex CHD are also at risk for sudden cardiac arrest and LGE data may assist in further risk stratification of these patients. Three complex CHD patients who all suffered myocardial infarctions at a young age as a result of their multifaceted cardiac history are highlighted to illustrate the importance of this (see included table, Figure 1). Two CMR images (Figures 2,3) demonstrate delayed enhancement throughout the septum at the base to mid-cavity in a patient with truncus arteriosus type 1 who presented with a non-ST-elevation myocardial infarction (NSTEMI). Focal area of low-signal sub-endocaridum within the enhancement on Figure 3 favors microvascular obstruction.

CMR is a vital component of surgical planning and post-operative care of patients with CHD, providing accurate anatomical, functional, and flow information that assists in clinical management. Delayed enhancement sequences and post-gadolinium T1 mapping allow assessment of ischemic injury or infarct, and therefore should be considered part of routine follow up CMR studies in patients with complex CHD. Read More

Authors:  Henault Kathryn , Upadhyay Shailendra , Herbst Timothy , O'loughlin Michael , Toro-salazar Olga

Keywords:  congenital heart disease, Cardiac MRI, myocardial infarction

Simmons Curtis,  Goncalves Luis,  Southard Richard,  Bardo Dianna

Final Pr. ID: Poster #: SCI-001

As more pediatric patients are infected with severe acute respiratory syndrome coronavirus 2 during the coronavirus disease 2019 (COVID-19) pandemic, more have been diagnosed with multisystemic inflammatory syndrome in children (MIS-C). Early research investigations into MIS-C show cardiac involvement presenting as elevated troponins, ventricular dysfunction, electrical conduction abnormalities, and pericardial effusions. MIS-C may result in myocardial perfusion defects visualized with nuclear medicine imaging and magnetic resonance imaging (MRI), however these perfusion defects on contrast enhanced computed tomography (CT) have not yet been described. Read More

Authors:  Simmons Curtis , Goncalves Luis , Southard Richard , Bardo Dianna

Keywords:  Cardiac, COVID

Rendon Kathleen,  Rigsby Cynthia

Final Pr. ID: Poster #: EDU-002 (T)

Purpose: The long-term effects from gadolinium tissue deposition in organs and the brain is unknown especially in children who may need repeated contrast studies for necessary follow-up of cardiovascular abnormalities. We aim to show the utility of a non-contrast MRA sequence in older children and young adults undergoing chest and/or abdominal MRA. Read More

Authors:  Rendon Kathleen , Rigsby Cynthia

Keywords:  Non-contrast, 3D imaging, Cardiac

Zucker Evan

Final Pr. ID: Poster #: EDU-093

Cardiomyopathy is rare in children but associated with significant morbidity and mortality when symptomatic. It also comprises a large proportion of cardiac MR imaging referrals in typical pediatric radiology practice. The purpose of this educational exhibit is to review the major types of cardiomyopathy in children, focusing on cardiac MRI. Read More

Authors:  Zucker Evan

Keywords:  Cardiomyopathy, Cardiac, MRI, Pediatric, Late gadolinium enhancement

Wu Jennifer,  Myers Ross,  Sadowsky David,  Li Tianyang,  Tsui Edison,  Sonke Pierre-yves

Final Pr. ID: Poster #: EDU-004

Congenital heart diseases often occurs secondary to a variety of insults and rotational errors during development in utero. These can range from a spectrum of simple to more complex pathologies including arterial switches. It is important for radiologists to recognize the embryology and complications of arterial switches to further management. Today largely secondary to new advances in technology both corrected and uncorrected arterial switches are diagnosed more commonly; previously many patients with arterial switches may not have survived into adulthood.

In utero, the primitive truncus is normally positioned anterior and midline. It eventually divides into the aorta and the pulmonary artery, which then rotates clockwise 150 degrees such that the pulmonary artery lies anterior to and left of the aorta. When variations occur it can result in a congenitally corrected transposition such as L- transposition of the great arteries (L-TGA) where the two ventricles are morphologically switched in position. With L-TGA, the truncus rotates 30-degrees clockwise which results in the aorta being anterior and leftward in relation to the pulmonary artery.

In uncorrected transposition (R-TGA) the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle, secondary to a 30-degree counterclockwise rotation of the primitive truncus, the aorta is then located rightward and anterior to the pulmonary artery. This condition needs to be corrected surgically due to cyanosis resulting from the right ventricle not being able to supply the systemic circulation. Other variations of arterial switches that can occur is situs inversus where the rotation of the aorta and pulmonary artery is completely opposite of that which would be considered normal. Lastly in truncus arteriosus, the primitive truncus does not divide into a separate aorta and pulmonary artery. We will provide several cases from our institution of arterial switches on imaging as well as diagramatic representative models describing the embryology of how arterial switches and rotations occur. We also discuss the repairs and complications of these cases. Read More

Authors:  Wu Jennifer , Myers Ross , Sadowsky David , Li Tianyang , Tsui Edison , Sonke Pierre-yves

Keywords:  cardiac, Pulmonary

Burns Madisen,  Cao Joseph

Final Pr. ID: Poster #: CR-008

Major aortopulmonary collateral arteries (MAPCAs) are congenital vessels derived from the splanchnic vascular plexus connecting the systemic circulation to the pulmonary arterial vasculature. These abnormal collateral vessels persist after birth when there is disruption of normal antegrade flow through the pulmonary arteries. MAPCAs are most commonly seen in patients with Tetralogy of Fallot with pulmonary atresia (TOF/PA).
Our patient was prenatally diagnosed with hypoplastic left heart syndrome (HLH) and anomalous pulmonary venous return. She was born at term with an initial CT angiogram showing obstructive supracardiac total anomalous pulmonary venous return (TAPVR) and a small sub-millimeter MAPCA. The patient underwent immediate vertical vein stenting and subsequently underwent Norwood and open TAPVR repair on day of life 16. She continued to clinically deteriorate due to elevated pulmonary arterial pressures and was eventually diagnosed with occlusion of her left pulmonary veins, confirmed on repeat CT angiography where the small MAPCA had increased to over 2 mm in size. The patient continued to experience pulmonary hypertension resulting in respiratory failure requiring intubation and eventual extracorporeal membranous oxygenation. She became hypoxic and bradycardic during operative tracheostomy placement and was unable to be resuscitated. Read More

Authors:  Burns Madisen , Cao Joseph

Keywords:  Pulmonary, Congenital, Cardiac

Burns Madisen,  Cao Joseph

Final Pr. ID: Poster #: EDU-009

This exhibit reviews the major congenital heart lesions affecting the right ventricular outflow tract (RVOT) and the surgical techniques performed in correcting these lesions. We explore the immediate post-surgical appearance of these cases through ultrasound echocardiography, CT angiography, and cardiac MR angiography. The final section reviews the more common complications seen with RVOT intervention. Read More

Authors:  Burns Madisen , Cao Joseph

Keywords:  Congenital, RVOT, Cardiac

Scace Candace

Final Pr. ID: Poster #: EDU-009

To provide a working knowledge of normal cardiac anatomy and a systematic guide to findings in common and uncommon congenital heart disease as seen on cardiac CTA. Read More

Authors:  Scace Candace

Keywords:  Congenital Heart Disease, Cardiac CTA, Presurgical CHD