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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
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Comparison between transthoracic echocardiography and cardiac magnetic resonance imaging in patients status post

Jason G Ho1, Mervyn D Cohen, Eric S Ebenroth

  • 1Section of Pediatric Cardiology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Ind 46202, USA.

Congenital Heart Disease
|October 21, 2011
PubMed

Insights

Cardiac magnetic resonance imaging offers superior image quality and baffle visualization compared to echocardiography in patients after atrial switch surgery, despite minimal cost differences. MRI is recommended for serial evaluations in this population.

Area of Science:

  • Cardiovascular imaging
  • Congenital heart disease
  • Medical technology assessment

Background:

  • Patients with transposition of the great arteries status post atrial switch require serial imaging evaluations.
  • Transthoracic echocardiography (TTE) is a common first-line imaging modality but has limitations.
  • Cardiac magnetic resonance imaging (CMR) offers potential advantages over TTE for evaluating this patient group.

Purpose of the Study:

  • To compare image quality, cost, right ventricular ejection fraction (RVEF) analysis, and baffle visualization between TTE and CMR.
  • To evaluate the utility of CMR as a primary imaging modality for patients status post atrial switch for transposition of the great arteries.

Main Methods:

  • A retrospective review of 12 patients who underwent both TTE and CMR within a mean of 157 days.
  • Independent analysis of image quality, RVEF, and baffle visualization by three physicians.
  • Comparison of institutional and Medicaid charges for both imaging modalities.

Main Results:

  • CMR demonstrated significantly higher image quality (P = .002) and better visualization of inferior vena cava baffles (33% vs. 97%, P = .002) compared to TTE.
  • TTE underestimated RVEF (36.1%) compared to CMR (47.8%, P = .002).
  • TTE was 18% and 38% less costly than CMR based on hospital charges and Medicaid reimbursement, respectively.

Conclusions:

  • CMR provides superior image quality and RVEF assessment compared to TTE in patients status post atrial switch.
  • CMR offers improved visualization of critical baffle structures.
  • CMR should be considered a first-line imaging modality for serial evaluation in this specific patient population, balancing diagnostic accuracy with cost-effectiveness.
Abstract

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