Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun;51(6):1699-1705.
doi: 10.1002/jmri.27012. Epub 2019 Dec 3.

Neopulmonary Outflow Tract Obstruction Assessment by 4D Flow MRI in Adults With Transposition of the Great Arteries After Arterial Switch Operation

Zahra Belhadjer  1   2   3 , Gilles Soulat  1   3   4 , Magalie Ladouceur  1   2   3   4 , Francesca Pitocco  3 , Antoine Legendre  2   3 , Damien Bonnet  2   4 , Laurence Iserin  2   3 , Elie Mousseaux  1   3   4
Affiliations

Neopulmonary Outflow Tract Obstruction Assessment by 4D Flow MRI in Adults With Transposition of the Great Arteries After Arterial Switch Operation

Zahra Belhadjer et al. J Magn Reson Imaging. 2020 Jun.

Abstract

Background: The main complication in adult patients with transposition of the great arteries (TGA) treated by an arterial switch operation (ASO) is neopulmonary outflow tract stenosis (NPOTS). However, pulmonary flow velocity measurements cannot always be performed with transthoracic echocardiography (TTE) due to complex anatomical features. 4D flow MRI allows detection, quantification, and location of the obstruction site along the NPOTS.

Purpose and hypothesis: To investigate the accuracy of 4D flow for the diagnosis of NPOTS in adults with TGA corrected by ASO.

Study type: Prospective.

Population: Thirty-three adult patients with TGA treated by ASO (19 men, mean age 25.5 years old).

Field strength/sequence: Accelerated 4D flow research sequence at 3T.

Assessment: Maximum NPOTS velocities on TTE and 4D flow MRI done the same day.

Statistical tests: Pearson correlation coefficient, paired t-test, and Bland-Altman analysis were used to investigate the relationship between TTE and MRI data.

Results: In 16 patients (48.5%), evaluation of NPOTS anatomy was not obtained by TTE, while it was always possible by 4D flow. Peak flow velocity (PV) measurements in Doppler and 4D flow were highly correlated (r = 0.78; P < 0.001). PV >350 cm.s-1 was detected in only one patient (3%) by TTE vs. five patients (15%) by 4D flow. Moreover, a high correlation was found between PV and the right ventricle (RV) mass index to body surface area when using 4D flow (r = 0.63; P < 0.001). The location of NPOTS was determined in all patients using 4D flow and concerned the main pulmonary artery in 42%.

Data conclusion: Compared to TTE, 4D flow MRI provides better sensitivity to detect and locate NPOTS in patients with TGA treated by ASO. 4D flow PV measurements in NPOTS were well correlated with TTE PV and RV mass.

Level of evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:1699-1705.

Keywords: 4D flow MRI; adult congenital heart disease; transposition of great arteries.

PubMed Disclaimer

References

    1. Brickner ME, Hillis LD, Lange RA. Congenital heart disease in adults. Second of two parts. N Engl J Med 2000;342:334-342.
    1. Lecompte Y, Zannini L, Hazan E, et al. Anatomic correction of transposition of the great arteries. J Thorac Cardiovasc Surg 1981;82:629-631.
    1. Angeli E, Raisky O, Bonnet D, Sidi D, Vouhé PR. Late reoperations after neonatal arterial switch operation for transposition of the great arteries. Eur J Cardiothorac Surg 2008;34:32-36.
    1. Khairy P, Clair M, Fernandes SM, et al. Cardiovascular outcomes after the arterial switch operation for D-transposition of the great arteries. Circulation 2013;127:331-339.
    1. Williams WG, Quaegebeur JM, Kirklin JW, Blackstone EH. Surgery for congenital heart disease. Cardiovasc Surg 1997Dec;114(6):975-987.

Publication types

LinkOut - more resources