Transatrial-Transpulmonary correction of TOF with CMR as a definitive diagnostic tool: Replacement of conventional cardioangiography
Journal Title: Journal of Medical Sciences - Year 2015, Vol 18, Issue 1
Abstract
INTRODUCTION: The objective of this study was to evaluate the associated cardiac anomalies, coronary and pulmonary artery abnormalities and aortopulmonary collaterals in patients of TOF with preoperative CMR and to correlate the CMR findings with intra-operative findings. METHODS: 28 patients (male: female ratio of 1:1.33) who had TOF were prospectively evaluated using CMR and underwent complete repair using the transatrial-transpulmonary approach. Efficacy of CMR as a tool for preoperative assessment of patients with TOF was evaluated by comparing CMR findings with intra-operative findings. RESULTS: On pre-operative CMR associated congenital cardiac anomalies were present in 13 patients including additional muscular VSD, coronary artery abnormalities, LSVC, PFO, PDA, right aortic arch and MAPCA's.Pulmonary artery variations were detected in 9 patients with LPA stenosis being the commonest lesion present in 3 patients followed by supravalvular stenosis and Isolated MPA hypoplasia. All the associated cardiac anomalies were confirmed intra-operatively except one MAPCA's in which PDA was found. One Mitral valve cleft found and repaired intra-operatively was missed by CMR and one LPA stenosis was over diagnosed on CMR. Post-repair RV/PA gradient was 10mmHg in 27 (96.43%) patients and one patient had 11mmHg. Mean post-repair Prv/Plv ratio was 0.51. CONCLUSIONS: In patients of TOF, CMR is superior to traditional echocardiography and alternative to conventional angiography which gives detailed anatomic and functional information without risk of radiation and contrast reactions to iodinated agents.
Authors and Affiliations
Mir Mudasir Sidiq, GN Lone, Khursheed Aslam, Naseer A Choh
Keywords
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