4D flow magnetic resonance imaging to assess right ventricular outflow tract in patients undergoing transcatheter pulmonary valve replacement

Clément Karsenty; Yousef Alattar; Elie Mousseaux; Gabrielle Marcilhacy; Umit Gencer; Damian Craiem; Laurence Iserin; Magalie Ladouceur; Antoine Legendre; Mikael Laredo; Damien Bonnet; Sophie Malekzadeh-Milani; Gilles Soulat

doi:10.1016/j.rec.2023.02.010

4D flow magnetic resonance imaging to assess right ventricular outflow tract in patients undergoing transcatheter pulmonary valve replacement

Rev Esp Cardiol (Engl Ed). 2023 Oct;76(10):793-802. doi: 10.1016/j.rec.2023.02.010. Epub 2023 Mar 14.

[Article in English, Spanish]

Affiliations

¹ Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Pediatric and Congenital Cardiology, Children's Hospital, CHU Toulouse, Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Toulouse, France; Adult Congenital Cardiology Department, Clinique Pasteur, Toulouse, France. Electronic address: clement.karsenty@hotmail.fr.
² Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
³ Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Paris Centre de Recherche Cardiovasculaire (PARCC), Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM) Paris, France.
⁴ Paris Centre de Recherche Cardiovasculaire (PARCC), Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM) Paris, France.
⁵ Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Buenos Aires, Argentina.
⁶ Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Institut de Cardiologie, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
⁷ Pediatric and Congenital Department, M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Paris, France; Institut IMAGINE, Université de Paris, Paris, France.
⁸ Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Pediatric and Congenital Department, M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Paris, France.

PMID: 36921915
DOI: 10.1016/j.rec.2023.02.010

Abstract

Introduction and objectives: Magnetic resonance imaging (MRI) including 4D flow is used before percutaneous pulmonary valve implantation (PPVI). As PPVI is limited by the size of the right ventricular outflow tract (RVOT), accurate sizing is needed to plan the intervention. The aim of this study was to compare different MRI modalities and invasive angiography to balloon sizing of RVOT.

Methods: Single-center prospective study of patients who underwent PPVI for isolated pulmonary regurgitation assessed by 4D flow MRI, 3D steady-state free precession/gradient echo (3D SSFP/GRE) and contrast magnetic resonance angiography. Balloon sizing was considered as the reference.

Results: A total of 23 adults were included (mean age, 38.4±12.5 years). Eighteen patients underwent successful primary PPVI. The average of the narrowest RVOT diameter was 25.4±4.3 mm by balloon sizing. Compared to balloon sizing, RVOT diameters were better correlated when estimated by systolic 4D flow MRI (r=0.89, P<.001) than by diastolic 4D flow MRI (r=0.71, P <.001), 3D contrast magnetic resonance angiography (r=0.73; P <.001) and 3D SSFP/GRE (r=0.50; P=.04) and was not significantly correlated when estimated by 2D in diastole and systole. The mean difference between systolic 4D flow MRI and balloon sizing was 0.2 mm (95%CI, -3.5 to 3.9 mm), whereas it was wider with other techniques.

Conclusions: Beyond the quantification of pulmonary valve regurgitation, 4D flow allows accurate estimation of RVOT diameters, especially in systole, which is fundamental before planning PPVI.

Keywords: 4D flow MRI; Insuficiencia; Magnetic resonance imaging; Pulmonary valve; Pulmonary valve insufficiency; RM con flujo 4D; Resonancia magnética; Tetralogy of Fallot; Tetralogía de Fallot; Válvula pulmonar.

MeSH terms

Adult
Heart Valve Prosthesis Implantation* / methods
Heart Valve Prosthesis*
Humans
Magnetic Resonance Angiography / methods
Magnetic Resonance Imaging / methods
Middle Aged
Prospective Studies
Pulmonary Valve Insufficiency* / diagnostic imaging
Pulmonary Valve Insufficiency* / surgery
Pulmonary Valve* / diagnostic imaging
Pulmonary Valve* / surgery
Tetralogy of Fallot*
Treatment Outcome