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Canadian Journal of Cardiology

Management of Patients With Single-Ventricle Physiology Across the Lifespan: Contributions From Magnetic Resonance and Computed Tomography Imaging

Published:January 17, 2022DOI:https://doi.org/10.1016/j.cjca.2022.01.011

      Abstract

      Cardiovascular magnetic resonance (CMR) and cardiac computed tomography (CCT) are robust cross-sectional imaging modalities that are increasingly being used to guide the diagnosis and management of those born with single-ventricle physiology. The purpose of this review is to acquaint the reader with the wide range of cross-sectional imaging applications that can be applied in this population. Illustrative examples of information provided by CMR and CCT are included, such as delineation of cardiac anatomy, measurement of ventricular volumetry, interrogation of vascular anatomy and flows, evaluation of myocardial viability, and exclusion of thromboembolic disease. Focus is placed on the appropriate selection and timing of advanced cardiac imaging modalities, and differentiations are made between established indications for imaging and emerging applications (such as 4-dimensional [4D] flow assessment and parametric imaging for identification of diffuse fibrosis using CMR). Potential CMR and CCT contributions in the selection of interventional strategies in the child and for surveillance of postoperative complications in the adult are highlighted. Furthermore, the importance of extracardiac cross-sectional imaging in the single-ventricle population is emphasized given the recognition that complications post-Fontan palliation are not limited to the cardiovascular system but will often include extracardiac manifestations of disease (such as hepatic disease or lymphatic abnormalities), While the value of CMR and CCT for contemporary clinical care of individuals born with single-ventricle physiology appears to be well-established, further research will be necessary to explore the impact of risk stratification using imaging biomarkers on clinical outcomes following Fontan palliation.

      Résumé

      La résonance magnétique cardiovasculaire (RMC) et la tomodensitométrie cardiaque (TDMC) sont des techniques d’imagerie transversale (par coupes) fiables de plus en plus employées pour orienter le diagnostic et la prise en charge chez les personnes nées avec un cœur univentriculaire. La présente revue vise à familiariser le lecteur avec les nombreuses applications de l’imagerie par coupes qu’il est possible d’utiliser dans cette population. Des exemples illustrent l’information fournie par la RMC et la TDMC, comme la représentation de l’anatomie cardiaque, la volumétrie ventriculaire, l’analyse de l’anatomie et du flux vasculaires, l’évaluation de la viabilité myocardique ainsi que l’exclusion de la maladie thromboembolique. L’accent est mis sur la sélection et le moment appropriés d’utilisation des techniques avancées d’imagerie cardiaque ainsi que sur les différences entre les indications établies de l’imagerie et les applications émergentes (comme la mesure quadridimensionnelle [4D] des flux et l’imagerie paramétrique pour la détection de fibrose diffuse au moyen de la RMC). Il est également question de l’utilité potentielle de la RMC et de la TDMC pour le choix de la stratégie interventionnelle chez l’enfant et la surveillance des complications postopératoires chez l’adulte. En outre, la revue traite de l’importance de l’imagerie transversale extracardiaque chez la population née avec un cœur univentriculaire, puisqu’il a été prouvé que les complications consécutives à l’intervention de Fontan ne se limitent pas à l’appareil cardiovasculaire, mais qu’elles prennent bien souvent la forme de manifestations extracardiaques (comme une maladie du foie ou une anomalie lymphatique). Bien que l’utilité de la RMC et de la TDMC pour les soins cliniques contemporains prodigués aux personnes nées avec un cœur univentriculaire semble bien établie, il faudra mener d’autres recherches pour explorer les répercussions de la stratification du risque à l’aide de biomarqueurs obtenus par imagerie sur les résultats cliniques à la suite d’une intervention de Fontan.
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