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

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

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

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

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

Nagy Eszter,  Marterer Robert,  Tschauner Sebastian,  Grangl Gernot,  Sorantin Erich

Final Pr. ID: Poster #: SCI-019

Right ventricular (RV) function represents a prognostic marker in patients with congenital heart defects (CHD), essentially in patients with right bundle branch block (RBBB). Due to the limitations of echocardiographic ventricle volume assessment, cardiac magnetic resonance imaging (CMR) is nowadays the method of choice in the follow-up of these patients.
In a recently published study it has been shown that delayed RV contraction due to RBBB should be taken into account when performing CMR volumetric assessment with short axis plane method.
Since recent recommendations suggest axial plane volume measurements, therefore current work was designed to assess the impact of RBBB on cardiac volumetric parameters evaluated with the axial plane method. Read More

Authors:  Nagy Eszter , Marterer Robert , Tschauner Sebastian , Grangl Gernot , Sorantin Erich

Keywords:  cardiac MRI, volumetry, congenital heart defects