Myocardial deformation in patients with a single left ventricle using 2D cardiovascular magnetic resonance feature tracking: a case-control study

Impact of cardiovascular magnetic resonance in single ventricle physiology: a narrative review

Background and Objective

Cardiovascular magnetic resonance (CMR) is a routine cross-sectional imaging modality in adults with congenital heart disease. Developing CMR techniques and the knowledge that CMR is well suited to assess long-term complications and to provide prognostic information for single ventricle (SV) patients makes CMR the ideal assessment tool for this patient cohort. Nevertheless, many of the techniques have not yet been incorporated into day-to-day practice. The aim of this review is to provide a comprehensive overview of CMR applications in SV patients together with recent scientific findings.

Methods

Articles from 2009 to August 2024 retrieved from PubMed on CMR in SV patients were included. Case reports and non-English literature were excluded.

Key Content and Findings

CMR is essential for serial follow-up of SV patients and CMR-derived standard markers can improve patient management and prognosis assessment. Advanced CMR techniques likely will enhance our understanding of Fontan hemodynamics and are promising tools for a comprehensive patient evaluation and care.

Conclusions

There is increasing research that shows the advantages of CMR in Fontan patients. However, further research about the prognostic role of CMR in older Fontan patients and how new methods such as modeling and deep learning pipelines can be clinically implemented is warranted.

A complex case of univentricular heart with multiple congenital malformations diagnosed in a newborn: a case report and literature review

Introduction

Univentricular heart disease is a relatively rare condition that affects infants, with a prevalence ranging from 0.05 to 0.1 per 1000 live births. It is characterized by an abnormality in the structure of the heart, specifically the presence of only one main pumping chamber (ventricle) instead of the usual two.

Presentation of case

In this particular case, a newborn male was diagnosed with double-inlet left ventricle (DILV), a specific form of univentricular heart disease. Following his birth, he exhibited symptoms of central cyanosis (a bluish tint to the skin due to poor oxygenation) and difficulties with breastfeeding. Clinical evaluation, along with a heart ultrasound, confirmed the need for palliative surgery. At the age of 6 months, the patient is scheduled to undergo the Glenn procedure, a surgical intervention that aims to redirect blood flow to the lungs and improve oxygenation.

Clinical discussion

Given the complexity of double-inlet single ventricle anomalies, there are multiple differential diagnoses that need to be considered for accurate diagnosis, including conditions such as tricuspid atresia, large ventricular septal defect and corrected transposition of the great arteries with ventricular septal defect.

Conclusion

Early intervention in the immediate postnatal period plays a crucial role in improving survival rates and reducing long-term complications. It is, therefore, essential to continue researching and refining treatment approaches.

Myocardial Deformation in the Pediatric Age Group: Normal Values for Strain and Strain Rate Using 2D Magnetic Resonance Feature Tracking

BACKGROUND

Myocardial deformation can be assessed from routine cardiac magnetic resonance (MR) images using two-dimensional feature tracking (2D-FT). Although reference values are essential for implementation of strain imaging in clinical practice, data for the healthy pediatric age group are limited.

PURPOSE

To provide pediatric MR reference values for strain and strain rate for all four heart chambers.

STUDY TYPE

Retrospective.

SUBJECTS

One hundred and fifty-seven healthy children from two institutions (102 male, age 4.7-18 years).

FIELD STRENGTH/SEQUENCE

1.5 T; balanced steady-state free precession sequence.

ASSESSMENT

Left ventricular (LV) global and regional longitudinal, circumferential, and radial strain and strain rate as well as right ventricular (RV) and atrial global and regional longitudinal strain and strain rate were measured in two-, three-, and four-chamber views and the short axis stack. The relationships between strain parameters and age, height, weight, and gender were investigated. Age- and height-specific centile curves and tables were created for LV strain and strain rate. For all other global strain parameters, the mean was calculated as a reference.

STATISTICAL TESTS

Lambda-mu-sigma (LMS)-method of Cole and Green, univariable, and multivariable linear regression models. A P value <0.05 was considered to be statistically significant.

RESULTS

Age, height and weight had a significant influence on LV global strain values. These parameters also showed an influence on RV strain but only in boys (girls P = 0.12) and none of the variables had a significant influence on atrial strain (P = 0.19-0.49). Gender differences were only found for RV strain values.

DATA CONCLUSION

Pediatric potential reference values for myocardial deformation parameters of both ventricles and atria are provided. The values may serve as a reference in future studies and clinical practice.

LEVEL OF EVIDENCE

3 TECHNICAL EFFICACY: Stage 5.