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Too Small, Too Thick and Too Big: CMR of the Left Heart and Aorta in Congenital Heart Disease

Non-invasive Imaging: Magnetic Resonance Imaging

Too small, too thick and too big. For the aorta and left ventricle, it seems that size does matter. Session 11 of SCMR 2015 was all about the size of left ventricular structures and their impact on blood flow, therapy and outcome of children with congenital heart diseases.

In the first talk, Dr Banka from Boston presented CMR parameters that could help support the decision making of surgical strategy in borderline left ventricles (BLV). She depicted the current difficulties regarding the choice for uni- or biventricular repair in BLV. Studying CMR characteristics of patients with BLV, she found that LV end diastolic volume, LV/RV stroke volume ratio and MV/TV inflow ratio were predictors of successful biventricular repair in BLV.

 In the following talk Dr Raimondi discussed the difficulties when assessing risk factors in children with hypertrophy cardiomyopathy and the need of diagnostic tools and prognostic biomarkers. She explained CMR findings in a group of 75 children with hypertrophic cardiomyopathy and showed that only 50% of the HCM patients in their follow-up study had an increased LV mass.  In 15% local scar tissue was seen on LGE (this characteristic was associated with very severe hypertrophy) and perfusion imaging was found to be normal. She concluded that in young patients, the LV-morphology might be a better predictor than LV mass, fibrosis or perfusion defects.

From the left ventricle we went on to the Aortic valve.

Dr Powell showed the usefulness of T1 mapping in adolescent patients with treated congenital aortic stenosis.  He showed that the extra cellular volume was higher when compared to healthy volunteers and that this fact, together with late gadolinium derived scar tissue was correlated to impaired diastolic function.

Dr Alex Barker went on to explain the possible implications of the use of 4D flow in the assessment of aortic arch abnormalities. He showed the impact of coarctation and dilatation of the aorta on the turbulence and energy loss of flow and its implication on wall shear stress. He discussed the possible usefulness of these measurements in future clinical practice.

To finalize the session, Dr Morris from Texas focused on Aortopathies associated with connective tissue disorders. She emphasized the lack of international agreement when assessing these patients. She proposes to standardize the method of aortic arch measurement. Dr Morris also underlined the significance of the vertebral tortuosity index and aortic stiffness in patients with these mutations.

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.