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Advanced technologies in CHD - fancy or useful?

Lecture Session II



Christian Meierhofer remembered Dr. Sohrab Fratz (1970-2016), CMR clinician, researcher, teacher, and gentleman. His talent to create networks in congenital CMR imaging made him well known and respected in the community.

Dr. Vivek Muthurangu pointed out at the beginning of his presentation the importance of the clinical impact of new imaging technologies. Fast MR imaging can be achieved with real-time sequences. Clinical application for real-time imaging include imaging small children, evaluating pulmonary hypertension and imaging during exercise. Dr. Muthurangu highlighted sequence modifications aimed to accelerate image acquisition and reconstruction, including new forms of parallel imaging, pattern of k-space filling (spiral, radial) and their combination for obtaining adequate spatial and temporal resolution.  As a practical clinical application, free-breathing time-resolved angiography was discussed, and validation data regarding imaging quality, sensitivity and specificity were presented.  By applying all different techniques, an entire CMR exam can be performed in 10-15 minutes, what has a real impact on patient’s satisfaction and eventually examination costs.

Dr. Lars Grosse-Wortmann started by introducing the concept of the ideal biomarker for fibrosis, which should be early, sensitive, causal, and modifiable. The most recent data on T1mapping and ECV measurement in different congenital heart disease (CHD), tetralogy of Fallot, aortic Stenosis, the right ventricle in systemic position, the single ventricle after Fontan palliation and the correlation with histology in transplanted hearts were presented. However fibrosis imaging in the right ventricle remains challenging, and other aspect are still unresolved: ECV values show a range of overlap between patients with different conditions and normal. Longitudinal and outcome data are needed, causes of fibrosis investigated and the difference between native T1 and ECV better understood.

Dr. Malenka Bissell gave a highly educational presentation on the applications of 4D flow in CHD. With the help of impressing images and the most recent available data she demonstrated how 4D flow can help improving imaging. The different flow visualization and the information on flow direction add new information to CMR examination. In bicuspid aortic valve, wall shear stress quantification helps to understand the disease, as it was demonstrated in adult and pediatric patients. The effects of surgical modifications can be easily visualized on 4D flow images. Finally by evaluating the intracardiac kinetic energy profile disease progression can be assessed in cardiomyopathies and in univentricular hearts. Challenges for the technique are lengthy acquisition and analysis time, the various ranges of velocities occurring concomitantly in CHD, and the need for further understanding what 4D can show and measure.

Silvia Schievano presented 3D printing as a new technology useful for complex lesions and in complex multidisciplinary teams. 3D models can be printed in different types of polymers and add additional value in communication, teaching and education. By using interventions in the right ventricular outflow tract and planning of valve replacement as an example, Dr.Schievano nicely demonstrated how 3D printing can be used for engineering procedures and applied for development of customer tailored devices.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.