MRI

Cardiac Magnetic Resonance Imaging Predictors of Short-Term Outcomes after High Risk Coronary Surgery

by

Sheriff MJ, Mouline O, Hsu C, Grieve SM, Wilson MK, Bannon PG, Vallely MP, Puranik R

Heart Lung Circ 2016 Jan;

PMID: 26839164

Abstract

BACKGROUND: The euroSCORE II is a widely used pre-coronary artery bypass graft surgery (CAGS) risk score, but its predictive power lacks the specificity to predict outcomes in high-risk patients (

METHODS: Fifty-two consecutive patients with high euroSCORE II (>16) and left ventricular (LV) dysfunction (<40%) based on 2D-echocardiography who underwent CAGS and in whom CMRI (1.5T) was performed preoperatively were retrospectively studied. Cardiac magnetic resonance imaging parameters were assessed in patients who either had complications immediately post-surgery (n=35), six weeks post-surgery (n=20) or were uncomplicated.

RESULTS: The average age of patients recruited was 69±5 years with high euroSCORE II (22±4) and low 2D-echocardiography LV ejection fraction (38%±2%). Cardiac magnetic resonance imaging results demonstrated that those with immediate complications had higher LV scar/infarct burden as a proportion of LV mass (17±3% vs 10±3%; p=0.04) with lower circumferential relaxation index (2.5±0.46 vs 2.8±0.56; p=0.05) compared to those with no complications. Early mortality from surgery was 17% (n=9) and was associated with lower RV stroke volume (55±12 vs 68±18; p=0.03) and higher LV infarct scar/burden (18±2% vs 10±2%, p=0.04). Cardiac magnetic resonance imaging showed patients with complications at six weeks post-surgery had higher LV scar/infarct burden (14.5±2% vs 6.8±2%, p=0.03) compared to those without complications.

CONCLUSION: Cardiac magnetic resonance imaging preoperative LV and RV parameters are valuable in assessing the likelihood of successful outcomes from CAGS in high-risk patients with LV dysfunction.

MRI in Chronic Aortic Dissection: A Systematic Review and Future Directions

by

Sherrah AG, Grieve SM, Jeremy RW, Bannon PG, Vallely MP, Puranik R

Front Cardiovasc Med 2015;2:5

PMID: 26664877

Abstract

The acute event of thoracic aortic dissection carries with it high mortality and morbidity. Despite optimal initial surgical or medical management strategies, the risk of further complications in the long-term, including aneurysmal dilatation and false lumen (FL) expansion, are not insignificant. Adequate follow-up of such conditions requires dedicated imaging where relevant prognostic indicators are accurately assessed. We perform a systematic review of the literature and report the current evidence for the use of magnetic resonance imaging (MRI) in assessment of chronic aortic dissection. We then make a comparison with traditional imaging modalities including computed tomography and echocardiography. We discuss new ways in which MRI may extend existing aortic assessment, including identification of blood-flow dynamics within the TL and FL using phase-contrast imaging.

Clinical utility of magnetic resonance imaging in the follow-up of chronic aortic type B dissection

by

Sherrah AG, Vallely MP, Grieve SM, Jeremy RW, Hendel PN, Puranik R

Heart Lung Circ 2014 Jul;23(7):e157-9

PMID: 24735714

Abstract

Several imaging modalities are utilised in the assessment of disease progression in chronic aortic dissection. We present the case of a 66 year-old male who underwent ascending aorta repair for Stanford type A aortic dissection. On follow-up the persisting dissection of the descending thoracic aorta was observed to regress on magnetic resonance imaging (MRI). MRI has several advantages over computed tomography (CT) scanning and echocardiography in the follow-up phase of this disease.

Detection of serious complications by MR imaging in asymptomatic young adults with repaired coarctation of the aorta

by

Padang R, Dennis M, Semsarian C, Bannon PG, Tanous DJ, Celermajer DS, Puranik R

Heart Lung Circ 2014 Apr;23(4):332-8

PMID: 24210077

Abstract

BACKGROUND: Despite early repair, patients with aortic coarctation (CoA) continue to have a reduced life expectancy due to the development of late complications. We sought to define the rate of aortic abnormalities in patients with previous CoA repair, referred for surveillance magnetic resonance (MR) imaging.

METHODS: We evaluated 59 asymptomatic adults consecutively for repaired CoA with MR imaging between 2008 and 2012.

RESULTS: Patients were aged 29 ± 8 (16-49) years; 34 males (58%) and 34 with bicuspid aortic valve (58%). Median age at the time of initial repair was two years. Surveillance MR imaging was performed 23 ± 8 years post-procedure. The three most common interventions performed were subclavian-flap repair (25%), end-to-end repair (33%) and patch aortoplasty (33%). Re-intervention with balloon angioplasty or repeat surgery had been performed in 22% of subjects. There were 28 cases of recoarctation (48%), of which seven were at least moderate in severity. Repair site and ascending aortic aneurysm occurred in eight (14%) and four (7%) subjects, respectively. Freedom from any degree of recoarctation and other aortic complications was observed in eight subjects (14%).

CONCLUSION: MR imaging detected a high rate of aortic abnormalities in asymptomatic adults after CoA repair, including 27% with clinically significant recoarctation and/or local aneurysm formation.

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