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Left-sided pulmonary venous pathway obstruction after Mustard operation
Claire Elizabeth Matthews1, Tarique Hussain, Chris Miles
1King's College London, London, UK. matthews@kcl.ac.uk
Congenital Heart Disease
|September 13, 2012
Summary
Pulmonary venous pathway obstruction (PVPO) after the Mustard operation can alter pulmonary artery flow. Phase-contrast MRI reveals flow patterns, with the RPA/left pulmonary artery ratio being a sensitive marker for PVPO.
Area of Science:
- Cardiology
- Medical Imaging
- Pediatric Surgery
Background:
- Pulmonary venous pathway obstruction (PVPO) is a significant complication following the atrial switch procedure for transposition of the great arteries (TGA).
- Echocardiographic assessment of unilateral PVPO can be challenging due to altered pulmonary arterial blood flow.
- Phase-contrast magnetic resonance imaging (PC-MRI) has shown potential in evaluating altered arterial flow patterns.
Purpose of the Study:
- To investigate arterial flow patterns in patients with unilateral PVPO after the Mustard operation.
- To assess the utility of PC-MRI in diagnosing PVPO in this patient population.
Main Methods:
- Retrospective review of 12 patients who underwent the Mustard operation and subsequent magnetic resonance imaging (MRI) between 2006 and 2011.
- Analysis of arterial flow patterns using PC-MRI.
Main Results:
- Three patients with left PVPO demonstrated over 65% of flow directed to the right pulmonary artery (RPA).
- One patient with severe obstruction exhibited continuous diastolic forward flow in the RPA and diastolic flow reversal in the left pulmonary artery.
Conclusions:
- The RPA/left pulmonary artery flow ratio is a sensitive indicator for PVPO.
- Reversed diastolic flow in the ipsilateral pulmonary artery and continuous flow in the contralateral pulmonary artery are specific markers for severe obstruction in the absence of pulmonary regurgitation.
- Routine use of branch pulmonary artery PC-MRI is recommended for patients post-atrial switch for TGA.
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