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Composite graft replacement of the ascending aorta: leakage detection with gadolinium-enhanced MR imaging
R Fattori1, B Descovich, P Bertaccini
1Institute of Radiology and Cardiovascular Surgery, Ospedale S Orsola, Bologna, Italy. ross@med.unibo.it
Purpose:
To assess the value of magnetic resonance (MR) imaging in the detection of postoperative complications after composite valve graft replacement.
Materials And Methods:
Spin-echo and gradient-echo MR imaging was performed in 52 patients 1/2 to 200 months after composite graft replacement of the ascending aorta (22 for dissection, 30 for aneurysm). The prosthetic aortic segment, distal and proximal anastomoses, general morphologic characteristics, and diameter of the reimplanted coronary arteries were evaluated. In patients with abnormal perigraft thickening, additional spin-echo imaging was performed after injection of gadopentetate dimeglumine.
Results:
Normal postoperative perigraft thickening (< or = 10 mm) was observed in 42 patients. Ten patients had abnormal periprosthetic thickening of 15-52 mm. Gadolinium-enhanced MR imaging demonstrated leakage in five of those 10 patients. The lack of enhancement excluded the presence of bleeding in the remaining five patients (three with chronic hematomas, one with infection, and one with granulation tissue). These findings were confirmed at surgery or with subsequent follow-up MR examinations.
Conclusion:
MR imaging was an optimal imaging modality for evaluating the morphologic characteristics of composite grafts and reimplanted coronary arteries. Gadolinium-enhanced MR imaging is a simple, accurate, and noninvasive method for detecting a leak, which necessitates urgent repeat surgery.
Insights
Magnetic resonance (MR) imaging effectively detects complications after composite valve graft replacement. Gadolinium-enhanced MR imaging accurately identifies leaks, guiding urgent surgical intervention for improved patient outcomes.
Area of Science:
- Cardiovascular imaging
- Surgical outcomes
- Medical diagnostics
Background:
- Composite valve graft replacement is a complex procedure for aortic disease.
- Postoperative complications require accurate and timely detection.
- Magnetic resonance (MR) imaging offers noninvasive visualization of cardiovascular structures.
Purpose of the Study:
- To evaluate the diagnostic value of MR imaging in identifying postoperative complications following composite valve graft replacement.
- To assess the efficacy of gadolinium-enhanced MR imaging in detecting periprosthetic leaks.
Main Methods:
- Fifty-two patients underwent spin-echo and gradient-echo MR imaging after ascending aorta composite graft replacement.
- Evaluation included the prosthetic segment, anastomoses, graft morphology, and coronary artery reimplantation.
- Gadolinium-enhanced MR imaging was used for patients with abnormal perigraft thickening.
Main Results:
- Forty-two patients showed normal perigraft thickening; ten had abnormal thickening (15-52 mm).
- Gadolinium-enhanced MR imaging revealed periprosthetic leaks in five of the ten patients with abnormal thickening.
- Absence of enhancement excluded leaks in the remaining five, with findings confirmed by surgery or follow-up.
Conclusions:
- MR imaging is optimal for assessing composite grafts and reimplanted coronary arteries.
- Gadolinium-enhanced MR imaging is a precise, noninvasive tool for detecting leaks requiring urgent surgery.