CT and MRI for Repaired Complex Adult Congenital Heart Diseases

Exploring the causal association between congenital heart disease and stroke based on two-sample Mendelian randomization

Background

Research into common pathological mechanisms and genetic factors is essential for better understanding, prevention and management of cardiovascular disease in congenital heart disease (CHD) survivors. This study aims to explore the possible causal associations between CHD and acquired cardiovascular diseases with the help of genetic instruments.

Methods

This study utilized summary data from genome-wide association studies (GWASs) of CHD (including congenital anomalies of great vessels and heart septal defect) and seven different cardiovascular diseases, employing a two-sample Mendelian randomization (MR) design. Analysis was conducted using the inverse variance weighted method (IVW), weighted median, weighted mode, and MR-Egger regression methods. Sensitivity analysis included MR-Egger, MR-PRESO, Cochran's Q, and leave-one-out.

Results

In this study, 15 instrumental variables related to CHD were selected [F-statistic =23.55 (21.27, 28.84)]. The IVW MR analysis revealed potential association between genetically predicted congenital anomalies of great vessels and higher risk of atrial fibrillation [odds ratio (OR) =1.07, 95% confidence interval (CI): 1.02-1.12, P=0.004], unspecified stroke (OR =1.07, 95% CI: 1.02-1.12, P=0.008) and ischemic stroke (OR =1.07, 95% CI: 1.01-1.14, P=0.02). No significant associations were observed between other factors. The MR-Egger regression results indicated that these analyses were not affected by horizontal pleiotropy. Leave-one-out analysis showed that the causal effects were not driven by any single mutation.

Conclusions

This study found a potential causal association between exposure to congenital anomalies of great vessels and higher risk of atrial fibrillation, stroke and ischemic stroke. Discussed genetic factors might potentially help to identify a higher risk of stroke and other cardiovascular diseases.

Imaging Lessons From Multidisciplinary Team Meetings at a Quaternary Referral Center: A Case-Based Review of Radiology Findings in Complex Adult Congenital Heart Disease

Optimal management of adult congenital heart disease (ACHD) requires a multidisciplinary team (MDT) approach, fostering a collaborative culture over an individualistic approach. Within this framework, subspecialty-trained radiologists provide crucial imaging expertise, supporting cardiologists, surgeons, and interventional cardiologists in diagnoses, treatment planning, and follow-up evaluations. Advanced imaging tools and a nuanced understanding of surgical and interventional procedures enable radiologists to provide valuable insights to clinicians. In this review, we discuss the structure of ACHD MDT meeting at a quaternary center, briefly review the general principles of interventions in ACHD and the subsequent complications encountered in adulthood, formulate an approach to imaging and reporting such complex repaired cases, and review the key information to be mentioned in the report for further surgery/intervention. In this review, we use the format of eight key take-home lessons from an MDT management practice in ACHD.

Contemporary multimodality non-invasive cardiac imaging protocols for tetralogy of Fallot

Tetralogy of Fallot is the most prevalent cyanotic congenital heart disease, requiring lifelong multimodality non-invasive cardiac imaging, such as echocardiography, cardiothoracic computed tomography, and cardiac magnetic resonance imaging. As imaging techniques continuously evolve and are gradually integrated into clinical practice, there is a critical need to update multimodality imaging protocols. Over the last two decades, cardiothoracic computed tomography imaging techniques have advanced remarkably, significantly enhancing its role in evaluating patients with tetralogy of Fallot. In this review, we describe contemporary multimodality non-invasive cardiac imaging protocols for tetralogy of Fallot, emphasizing the expanding role of cardiothoracic computed tomography. Additionally, we present standardized reporting forms designed to facilitate the clinical adoption of these protocols.

Pulmonary Artery Stump Thrombus in a Patient With Remote History of Rastelli Procedure

•Atrial tachyarrhythmia may develop in Rastelli patients after decades. •Thrombus can form in the PA stump after the Rastelli procedure. •TEE remains crucial to rule out intracardiac thrombus before cardioversion.

Prevalence of Branch Pulmonary Artery Reintervention Following the Arterial Switch Operation

BACKGROUND

The arterial switch operation (ASO) is the preferred surgical procedure used to correct dextro-transposition of the great arteries. A known complication of the ASO is branch pulmonary arteries (PAs) stenosis, which may require reintervention. Our goal is to determine the frequency of reintervention after the ASO and any factors associated with reintervention.

METHODS

This was a single center, retrospective study of infants who underwent the ASO from June 6, 2011 to February 21, 2021. The primary outcome was the prevalence of reintervention on the PAs following the ASO.

RESULTS

Sixty-eight infants were analyzed; 9 (13%) patients had 10 reinterventions. The mean age at time of the ASO was 6.52 ± 6.63 days; weight was 3.34 ± 0.57 kg. Those with a reintervention had a longer bypass time (P = .047). Mean age at reintervention was 0.80 ± 0.72 years; mean time from the ASO to reintervention was 0.799 ± 0.717 years. Six surgical procedures, two stent placements, and four balloon angioplasties were performed on a total of 13 branch PAs. There was no increased risk for reintervention on the right versus left PA. After reintervention, there was an improvement in the minimal PA diameter and echo gradient. There were no adverse events or mortality related to the reintervention. Mean follow-up was 6.17 ± 2.94 years.

CONCLUSION

The prevalence of branch PA reintervention following the ASO in our cohort was 13%. There is an association between longer cardiopulmonary bypass time and reintervention. After reintervention, there was an increase in PA diameter and a decrease in echo gradient.

Right ventricular dilatation score: a new assessment to right ventricular dilatation in adult patients with repaired tetralogy of Fallot

BACKGROUND

Patients with repaired tetralogy of Fallot (rTOF) experience long-term chronic pulmonary valve regurgitation resulting in right ventricular (RV) dilatation. According to current guidelines, the evaluation of patients with rTOF for RV dilatation should be based on cardiac magnetic resonance (CMR). However, for many asymptomatic patients, routine CMR is not practical. Our study aims to identify screening methods for CMR based on echocardiographic data, with the goal of establishing a more practical and cheap method of screening for severity of RV dilatation in patients with asymptomatic rTOF.

METHODS

Thirty two rTOF patients (mean age, 21(10.5) y, 21 males) with moderate to severe pulmonary regurgitation (PR) were prospectively recruited. Each patient received CMR and echocardiogram examination within 1 month prior to operation and collected clinical data, and then received echocardiogram examination at discharge and 3-6 months post-surgery.

RESULTS

RV moderate-severe dilatation was defined as right ventricular end-diastolic volume index (RVEDVI) ≥ 160 ml/m2 or right ventricular end-systolic volume index (RVESVI) ≥ 80 ml/m2 in 15 of 32 patients (RVEDVI, 202.15[171.51, 252.56] ml/m2, RVESVI, 111.99 [96.28, 171.74] ml/m2). The other 17 (RVESDI, 130.19 [117.91, 139.35] ml/m2, RVESVI = 67.91 [63.35, 73.11] ml/m2) were defined as right ventricle mild dilatation, i.e., RVEDVI < 160 ml/m2 and RVESVI < 80 ml/m2, and the two parameters were higher than normal values. Compared with the RV mild dilatation group, patients of RV moderate-severe dilatation have worse cardiac function before surgery (right ventricular ejection fraction, 38.92(9.19) % versus 48.31(5.53) %, p < 0.001; Left ventricular ejection fraction, 59.80(10.26) versus 66.41(4.15), p = 0.021). Patients with RV moderate-severe dilatation faced longer operation time and more blood transfusion during operation (operation time, 271.53(08.33) min versus 170.53(72.36) min, p < 0.01; Intraoperative blood transfusion, 200(175) ml versus 100(50) ml, p = 0.001). Postoperative RV moderate-severe dilatation patients have poor short-term prognosis, which was reflected in a longer postoperative hospital stay (6.59 [2.12] days versus 9.80 [5.10] days, p = 0.024) and a higher incidence of hypohepatia (0[0] % versus 4[26.7] %, p = 0.023). Patients with RV dilatation score > 2.35 were diagnosed with RV moderate-severe dilatation (AUC = 0,882; Sensitivity = 94.1%; Specificity = 77.3%).

CONCLUSIONS

RV moderate-severe dilatation is associated with worse preoperative cardiac function and short-term prognosis after PVR in rTOF patients with moderate to severe PR. The RV dilatation score is an effective screening method. When RV dilatation score > 2.35, the patient is indicated for further CMR examination and treatment.

Comparison of blood pool and myocardial 3D printing in the diagnosis of types of congenital heart disease

The study aimed to evaluate the effectiveness of blood pool and myocardial models made by stereolithography in the diagnosis of different types of congenital heart disease (CHD). Two modeling methods were applied in the diagnosis of 8 cases, and two control groups consisting of experts and students diagnosed the cases using echocardiography with computed tomography, blood pool models, and myocardial models. The importance, suitability, and simulation degree of different models were analyzed. The average diagnostic rate before and after 3D printing was used was 88.75% and 95.9% (P = 0.001) in the expert group and 60% and 91.6% (P = 0.000) in the student group, respectively. 3D printing was considered to be more important for the diagnosis of complex CHDs (very important; average, 87.8%) than simple CHDs (very important; average, 30.8%) (P = 0.000). Myocardial models were considered most realistic regarding the structure of the heart (average, 92.5%). In cases of congenital corrected transposition of great arteries, Williams syndrome, coronary artery fistula, tetralogy of Fallot, patent ductus arteriosus, and coarctation of the aorta, blood pool models were considered more effective (average, 92.1%), while in cases of double outlet right ventricle and ventricular septal defect, myocardial models were considered optimal (average, 80%).

A Comprehensive Updated Review on Magnetic Nanoparticles in Diagnostics

Magnetic nanoparticles (MNPs) have been studied for diagnostic purposes for decades. Their high surface-to-volume ratio, dispersibility, ability to interact with various molecules and superparamagnetic properties are at the core of what makes MNPs so promising. They have been applied in a multitude of areas in medicine, particularly Magnetic Resonance Imaging (MRI). Iron oxide nanoparticles (IONPs) are the most well-accepted based on their excellent superparamagnetic properties and low toxicity. Nevertheless, IONPs are facing many challenges that make their entry into the market difficult. To overcome these challenges, research has focused on developing MNPs with better safety profiles and enhanced magnetic properties. One particularly important strategy includes doping MNPs (particularly IONPs) with other metallic elements, such as cobalt (Co) and manganese (Mn), to reduce the iron (Fe) content released into the body resulting in the creation of multimodal nanoparticles with unique properties. Another approach includes the development of MNPs using other metals besides Fe, that possess great magnetic or other imaging properties. The future of this field seems to be the production of MNPs which can be used as multipurpose platforms that can combine different uses of MRI or different imaging techniques to design more effective and complete diagnostic tests.