Abstract 13750: Cardiac Magnetic Resonance to Predict Coronary Artery Compression in Patients Undergoing Transcatheter Pulmonary Valve Implantation Into Conduits

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ryan A Romans ◽  
Jimmy C Lu ◽  
Wendy Whiteside ◽  
Sunkyung Yu ◽  
Osamah Aldoss ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Pulmonary Valve ◽  
Subjective Assessment ◽  
Qualitative Assessment ◽  
Coronary Anatomy ◽  
Valve Implantation ◽  
Coronary Compression ◽  
Stenotic Area

Introduction: Transcatheter pulmonary valve implantation (TPVi) is a widely available option to treat right ventricular outflow tract (RVOT) conduits, but coronary artery compression is an absolute contraindication. Cardiac magnetic resonance (CMR) may evaluate coronary anatomy, but its utility in predicting coronary compression is not well established. Hypothesis: CMR prior to TPVi can accurately predict coronary compression risk. Methods: We analyzed all patients with a recent CMR (≤ 12 months) and attempted TPVi in an RVOT conduit at 9 centers from 2007-2016. A core lab reviewed all CMRs for the shortest orthogonal distance from a coronary artery to the conduit, the shortest distance from a coronary artery to the most stenotic area of the conduit, and subjective assessment of coronary compression risk. Receiver operating characteristic curve was used to determine optimal predictive distances. Univariate and independent associations of the distances and qualitative assessment with coronary compression were examined using logistic regression. Results: Of 231 patients (62% male, median age 19.0 years), TPVi was successful in 198 (86%); in 24 (10%) balloon testing (documented coronary compression or high risk) precluded implantation. Distance to the RV to PA conduit ≤ 2.1 mm (area under the curve [AUC] 0.70) and distance to most stenotic area ≤ 13.1 mm (AUC 0.69) predicted coronary compression (Table). Subjective assessment had the highest AUC (0.78), with 96% negative predictive value. Both distances and qualitative assessment remained independently associated with coronary compression when controlling for abnormal coronary anatomy. Conclusions: CMR can predict the risk of coronary compression during TPVi in RVOT conduits but cannot completely exclude the risk of coronary compression. CMR may assist in patient selection and counselling families prior to TPVi, although balloon testing prior to TPVi remains essential.

scholarly journals Cardiac Magnetic Resonance to Evaluate Percutaneous Pulmonary Valve Implantation in Children and Young Adults

2018 ◽  
Vol 45 (2) ◽  
pp. 63-69
Author(s):  
Cesar Gonzalez de Alba ◽  
Fernando Molina Berganza ◽  
John Brownlee ◽  
Muhammad Khan ◽  
Dilachew Adebo
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Coronary Artery ◽  
High Risk ◽  
Magnetic Resonance ◽  
Coronary Angiography ◽  
Pulmonary Valve ◽  
Percutaneous Pulmonary Valve Implantation ◽  
Valve Implantation ◽  
Percutaneous Pulmonary Valve ◽  
Pulmonary Valve Implantation

Experience with cardiac magnetic resonance to evaluate coronary arteries in children and young adult patients is limited. Because noninvasive imaging has advantages over coronary angiography, we compared the effectiveness of these techniques in patients who were being considered for percutaneous pulmonary valve implantation. We retrospectively reviewed the cases of 26 patients (mean age, 12.53 ± 4.85 yr; range, 5–25 yr), all of whom had previous right ventricular-to-pulmonary artery homografts. We studied T2-prepared whole-heart images for coronary anatomy, velocity-encoded cine images for ventricular morphology, and function- and time-resolved magnetic resonance angiographic findings. Cardiac catheterization studies included coronary angiography, balloon compression testing, right ventricular outflow tract, and pulmonary artery anatomy. Diagnostic-quality images were obtained in 24 patients (92%), 13 of whom were considered suitable candidates for valve implantation. Two patients (8%) had abnormal coronary artery anatomy that placed them at high risk of coronary artery compression during surgery. Twelve patients underwent successful valve implantation after cardiac magnetic resonance images and catheterization showed no increased risk of compression. We attempted valve implantation in one patient with unsuitable anatomy but ultimately placed a stent in the homograft. Magnetic resonance imaging of coronary arteries is an important noninvasive study that may identify patients who are at high risk of coronary artery compression during percutaneous pulmonary valve implantation, and it may reveal high-risk anatomic variants that can be missed during cardiac catheterization.

Emergency surgery for extrinsic coronary compression after percutaneous pulmonary valve implantation

2012 ◽  
Vol 23 (3) ◽  
pp. 463-465 ◽  
Author(s):  
Lucia Mauri ◽  
Alessandro Frigiola ◽  
Gianfranco Butera
Keyword(s):  
Coronary Artery ◽  
Pulmonary Valve ◽  
Fatal Complication ◽  
Extrinsic Compression ◽  
Melody Valve ◽  
Percutaneous Pulmonary Valve Implantation ◽  
Valve Implantation ◽  
Coronary Compression ◽  
Percutaneous Pulmonary Valve ◽  
Pulmonary Valve Implantation

AbstractCoronary artery compression is a rare and potentially fatal complication after percutaneous pulmonary valve implantation. We report on a case of an acute antero-septal non-ST myocardial infarction secondary to the partial laceration of the conduit and the creation of a thrombus giving an extrinsic compression of left anterior descendent coronary artery after Melody valve implantation.

Cardiac magnetic resonance before and after percutaneous pulmonary valve implantation

2013 ◽  
Vol 119 (6) ◽  
pp. 400-407 ◽  
Author(s):  
Francesco Secchi ◽  
Elda Chiara Resta ◽  
Luciane Piazza ◽  
Gianfranco Butera ◽  
Giovanni Di Leo ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Pulmonary Valve ◽  
Percutaneous Pulmonary Valve Implantation ◽  
Before And After ◽  
Valve Implantation ◽  
Percutaneous Pulmonary Valve ◽  
Pulmonary Valve Implantation

Abstract 15075: Exercise Stress Testing and Stress Cardiac Magnetic Resonance Imaging for Detection of Inducible Ischemia in a Large Cohort of Children With Anomalous Aortic Origin of a Coronary Artery

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Amna Qasim ◽  
Tam Doan ◽  
Tam Dan Pham ◽  
Dana Reaves-O’Neal ◽  
Silvana M Molossi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cardiac Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Cardiac Magnetic Resonance Imaging ◽  
Exercise Stress ◽  
Resonance Imaging ◽  
Inducible Ischemia ◽  
St Depression ◽  
Stress Cardiac Magnetic Resonance

Introduction: The current AATS and AHA/ACC guidelines recommend maximal exercise stress test (mEST) to identify ischemia and direct decision-making in patients (pts) with anomalous aortic origin of a coronary artery (AAOCA). Stress cardiac magnetic resonance imaging (sCMR) has reliably identified myocardial perfusion abnormalities. Hypothesis: We hypothesize that EST and sCMR do not agree in the detection of inducible ischemia in AAOCA. Methods: AAOCA pts <21 years old were prospectively enrolled and evaluated following a standardized approach from 12/2012-12/2019. mEST was performed in pts ≥6 years old, except those who presented with cardiac arrest or physical limitations. Demographic data, coronary anomaly type, EST (symptoms, ST changes, arrhythmias, metabolic parameters) and sCMR data were collected. A mEST was defined as max HR ≥85%ile with a subgroup defined as respiratory exchange ratio (RER) >1.05. Abnormal mEST included: significant ST changes (≥1 mm horizontal or downsloping ST-depression, ≥2 mm upsloping ST depression, ST elevation), high-grade arrhythmia, abnormal peak VO2 (<85% predicted). Continuous and categorical variables were compared using Wilcoxon-Rank sum and Fisher’s exact/χ2 respectively. McNemar’s test was used to determine the agreement between EST and sCMR. Results: Of 147 pts with AAOCA and both EST and sCMR, 140 achieved max HR ≥85%ile on EST. Table 1 compares demographics and EST parameters in pts with inducible ischemia on sCMR (+sCMR) vs without (-sCMR). Significant ST changes were seen in 2/26 (7.7%) pts with +sCMR compared to 8/114 (7%) pts with -sCMR. An abnormal mEST did not agree with sCMR in identifying inducible ischemia (McNemar p < 0.001) in all AAOCA patients who achieved max HR, nor in the sub-group with RER >1.05 (n = 88). Conclusions: mEST does not agree with sCMR in identifying inducible ischemia in patients with AAOCA. Our data suggest that mEST should not be used alone for the detection of inducible ischemia.

Sign in / Sign up

Export Citation Format

Share Document