Swedish team uses MRI to help diagnose congenital heart defects


The results suggest that cardiovascular MRI could improve treatment and management plans for infants with congenital heart defects and counseling for their parents, wrote a team led by Dr Daniel Salehi of Lund University in Sweden.

“In [our] cohort study of 31 fetuses referred for fetal cardiovascular magnetic resonance imaging, additional clinically useful information regarding cardiovascular anatomy and function was obtained in 84% of referred cases, covering a wide range of congenital heart defects The group noted. “This information affected the choice. mode of delivery, planning for early postnatal care and parental counseling. “

Assessment of atrial restriction in a fetus with hypoplastic left heart syndrome. Fetal echocardiography could not visualize the atrial cavity or Doppler flow through the atrial septum due to poor acoustic windows (A). Fetal cardiovascular MRI showed significant interatrial communication, indicated by the asterisk, and no nutmeg pattern (B). Therefore, the risk of restrictive atrial septum was considered low (although a membrane could not be excluded), and the fetus was scheduled for a vaginal delivery with no cardiac catheterization laboratory pending. The contrast and brightness of the cardiovascular MRI image has been optimized for printing. All figures are courtesy of JAMA network open.

Although congenital heart defects affect only 1% of children, they account for 30% of infant mortality caused by birth defects. Complex defects requiring intervention in the child’s first year account for 25% of all cases, the group noted.

Congenital heart defects are usually identified in utero by echocardiography, but sometimes this modality is inconclusive due to inadequate acoustic windows. In recent years, researchers have developed an MRI-compatible Doppler ultrasound device that enables the acquisition of high-resolution fetal cardiovascular (CMR) MRI images without post-processing.

Salehi and his colleagues sought to study the effectiveness of fetal RMC after inconclusive echocardiography, as well as whether its use resulted in changes in patient management or parental advice. The team conducted a study of 31 fetuses referred for cardiovascular MRI at Skåne University Hospital in Lund between January 2017 and June 2020; the fetuses had a median gestational age of 36 weeks.

Baseline Assessment in a Fetus with Risk Factors for Heart Defects and a Very Low Acoustic Window

Baseline assessment in a fetus with risk factors for cardiac malformation and a very low acoustic window. The heart and fetal vessels were not at all visible on the fetal echocardiogram, due to the mother’s obesity (A). Fetal cardiovascular MRI showed normal sized ventricles with normal systolic function and at least one normal pulmonary vein (PV) with no obvious direct or indirect signs of aberrant pulmonary veins (B), superior vena cava (SV) and inferior vena cava veins (IVC) and normal ascending aorta (Ao) (C) and normal main pulmonary artery (MPA) (D). This information excluded major congenital heart disease and delivery was scheduled at the hospital closest to the patient’s home. Elective postnatal echocardiography was performed before discharge, which showed normal cardiovascular anatomy.

The authors found that cardiovascular MRI affected patient management and / or parental advice in 84% of cases, and added useful information for diagnosis and / or management in the following situations:

  • 80% of fetuses with aortic arch anatomy, including signs of coarctation
  • 87% of fetuses with univentricular versus biventricular outcome in borderline left ventricle, unbalanced interatrial communication and pulmonary atresia with an intact ventricular septum
  • 75% of fetuses with hypoplastic left heart syndrome
  • 68% of parental counseling cases

“These results suggest that fetal CMR has the potential to affect clinical decision making in difficult cases of congenital heart defects with inconclusive echocardiography data,” the team concluded.

Yes, fetal CMR shows promise for diagnosing prenatal congenital heart disease, but don’t throw out the echocardiogram, warned Dr Bhawna Arya of Seattle Children’s Hospital, U.S., in an accompanying commentary.

“The usefulness of fetal CMR is limited to late gestations, as a larger fetal size facilitates static magnetic resonance imaging. … Fetal echocardiography, on the other hand, can identify significant congenital heart disease as early as week 12. gestation, ”Arya wrote.

“Although fetal CMR offers an attractive opportunity for advanced and late gestational imaging, fetal echocardiography remains the gold standard for the early and accurate in utero diagnosis and monitoring of congenital heart disease and other diseases. fetal cardiovascular disease, ”she concluded.

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