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(Circulation. 2005;112:3256-3263.)
© 2005 American Heart Association, Inc.

Congenital Heart Disease

Cardiac Magnetic Resonance Imaging After Stage I Norwood Operation for Hypoplastic Left Heart Syndrome

Vivek Muthurangu, BSc, MB,ChB, MRCPCH; Andrew M. Taylor, MD, MRCP, FRCR; Sanjeet R. Hegde, MBBS, MRCPCH; Robert Johnson, BA, BM, MRCP; Robert Tulloh, DM, MRCP, FRCPCH; John M. Simpson, MD, FRCP; Shakeel Qureshi, MBBS, FRCP; Eric Rosenthal, MD, FRCP; Edward Baker, MD, FRCP; David Anderson, MB,BCh, FRCS; Reza Razavi, MD, MRCP, MRCPCH

From the Cardiac MR Research Group (V.M., A.M.T., S.R.H., R.J., R.R.), Division of Imaging Sciences, King’s College London, and Department of Congenital Heart Disease (R.T., J.M.S., S.Q., E.R., E.B., D.A., R.R.), Guy’s Hospital, London, United Kingdom; and Cardiothoracic Unit (A.M.T.), Institute of Child Health and Great Ormond Street Hospital for Children, London, United Kingdom.

Correspondence to Prof Reza Razavi, Cardiac MR Research Group, Division of Imaging Sciences, 5th Floor, Thomas Guy House, Guy’s Hospital, London, SE1 9RT, United Kingdom. E-mail reza.razavi{at}kcl.ac.uk

Received January 20, 2005; de novo received February 17, 2005; revision received June 16, 2005; accepted August 22, 2005.

Background— After the Norwood operation, a patient’s suitability for proceeding to a bidirectional cavopulmonary connection (BCPC) is assessed by a combination of echocardiography and diagnostic cardiac catheterization. In this study, we describe the results of 37 patients who underwent cardiovascular magnetic resonance (MR) assessment before BCPC.

Methods and Results— Cardiovascular MR and echocardiography were performed in 37 infants with hypoplastic left heart syndrome before BCPC, and the findings were compared with surgical findings. MR assessment of ventricular function and valvar regurgitation were compared with echocardiography. MR exhibited high sensitivity and specificity for identification of neoaortic (sensitivity 86%, specificity 97%) and left pulmonary artery (sensitivity 100%, specificity 94%) obstruction. Echocardiography exhibited poor sensitivity for identification of vascular stenosis. The mean right ventricular ejection fraction calculated from the MR data was 50±10%. There was general agreement between MR and echocardiographic measures of ventricular function, although patients with good function on echocardiography demonstrated a wide range of ejection fractions. There was good agreement between MR and echocardiography for identification of valvar regurgitation.

Conclusions— Cardiovascular MR can be used to define ventricular and valvar function and vascular anatomy in infants with hypoplastic left heart syndrome after the Norwood operation. We have shown how this information can be used to plan the BCPC and identify any revisions or additional valvar surgery.

Key Words: heart defects, congenital • magnetic resonance imaging • pediatrics • surgery

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