Tof Mri Study Of The Anatomy And Cardiac Function

Objectives:To study the value of MRI in diagnosis of TOF with pulmonary dysplasia using two index:Mcgoon ratio and Pulmonary artery index(PAI).Materials and Methods:41 cases of patients with TOF were selected from 88 cases of congenital heart disease admitted in the first affiliated hospital of Guangxi medical university from May 2003 to December 2006.In the 41 cases,25 males and 16 females,age from 3 years to 26 years,meaning age 11.6 years.Body surface areas(BSA)were 0.60m~2～1.80m~2,average 1.03±0.24m~2. In addition,9 cases of death were selected as an group for evaluation of operational curative effect.All patients was underwent MRI and ultrasound cardiography(UCG)examination before operation.Nine patients with TOF were dead after operation,twelve cases of TOF patients reviewed with MRI and UCG postoperation within one week to one month.Besides,30 healthy volunteers were set as control group,15 males and 15 females,age from 3 years to 31 years, mean age 22.7 years,BSA were 1.34m~2～1.84m~2,average 1.57±0.27m~2.All of them were underwent MRI exam for contrast.MRI equipments was Signa 1.5T superconduct scanner produced by Am GE company,body phase array coil was used.UCG facilities was Sonos 5500 and Sonos 7500 ultrasound scanners producted by Am HP company.The detector S4 frequence was 2.0～4.0 MHz,detector S3 was 1.0～3.0 MHz.Scan sequence included:Double inverse fast spin echo sequence(DIRFSE),fast imaging employing steadystate acquisiton(FIASTA)and phase contrast flow MR imaging(PC MRI).MRI scan steps:(1)First scaned with DIRFSE sequence,scaned section included transverse plane,ventricular short axial plane and ventricular long axial plane, pulmonary long axial plane and double oblique plane.(2)then selectively scaned two or more section in(1)with FIESTA sequence.(3)then scaned pulmonary transections with PC MRI.(4)Image data were disposed in GE ADW4.2 workstation with flow analysis software(Cv-FLOW).3.Study indexs: mophological index:MPA,LPA,RPA,AAO,DAO,OTRV,DRVW;pulmonary dynamic indexs:Vmmpa,Vmlpa,Vmrpa,Vpmap,FVmpa,FVlpa,Fvrpa; calculated Mcgoon ratio,PAI and Vp/Vm with equation.4.Study items:(1) Observed the mophological appearance of TOF group and compared with operational finding.(2)Calculated pulmonary and cardiac indexs of TOF group and contrasted with normal control group.(3)Analysis the correlativity of results tested by MRI and UCG respectively.(4)Investigated the change of morphology and flow dynamics of pulmonary arteries and heart pre and postoperation.Results:1.MRI findings preoperation:(1)Pulmonary stenosis(41 cases) presented as the thickening of outflow wall with confined cavity;pulmonary valves were thickening and limitively open;the main and bilateral pulmonary branches stenosis were seen in most of patients.Statistical results:the MPA, LPA,McGoon ratio and PAI of TOF group were all smaller than that in control group(P＜0.05);Vmmpa was smaller in TOF group than that in control group(P＜0.05);but the Vpmap and Vp/Vm were higher in TOF group than that in control group(P＜0.05).In contrast with UCG,we found that Vpmpa and Vp/Vm tested by MRI had positive correlativity with PG tested by UCG(r=0.63,P＜0.05).Grouped by the obstructed locas of pulmonary,we found that the FVmpa in the group with right ventricular outflow obstruction was evidently higher than that in the group with outflow tract and pulmonary stenosis;The Vpmpa in the group just with outflow tract and another group with pulmonary valve stenosis was evidently faster than that in the group with outflow obstruction,and outfolw tract and main pulmonary stenosis.We also found that the Vpmpa had a positive relation with the degree of outflow stenosis, size of VSD and thickeness of right ventricular anterior wall(DRVW).(2) Ventricular septal defect(41 cases)presented as the signal losed in the upper part of ventricular septum.The size of VSD was ranged from 0.9cm to 2.0cm, average 1.24cm.(3)Aortic override presented as the ascending aorta moved forword and overrided ventricular septum.The percentage of aortic override were ranged from 30%to 70%,average 55.33%.(4)Right ventricular hypertrophy presented as the thickening of right ventricular wall.The thickeness of right ventricular anterior wall(DRVW)were ranged from 6mm～20mm,average 26mm.(5)Extracardiac malformations including 11 cases of systemic-pulmonary collateral branch,6 cases of left superior vena cava,5 cases of right descending aorta,1 case of left pulmonary absence.The diagnosic rate of MRI was higher than UCG in extracardiac malformation(x 2 = 62.57, P＜0.01).2.Results after operation:The PAI of death was obviously lower than the survival.It revealed a greatly enlarged in MPA and OTRV(p＜0.05),PAI was increasing but not significant.Aortic override were cured.PAVmax,PG, Vpmpa,Vp/Vm were discended significantly(p＜0.05).Conclusions:(1)The study result indicated that MRI was an optimal metod in diagnosis of complex congenital heart disease.(2)PAI and Mcgoon ratio measured by MRI could reflect the growth of pulmonary atrery,that would be very helpful to evaluate pulmonary development condition preoperation and postoperation.(3)Vpmpa,Vp/Vm and FVmpa could demostrate the pulmoanry dynamic change and reflect the tension gap between right ventricle and pulmonary artery indirectly,that would help to evaluate the pulmonary dynamic situation before and after operation. Objective:To approach the clinical application of MRI in evalution of ventricular function of TOF.Materials and Methods:30 patients with TOF were selected from 88 cases of TOF patients confirmed by operation admitted in the first affiliated hospital of Guangxi medical university from May 2004 to December 2006.22 male and 8 female,age from 5 years to 26 years,mean age 12.5 years.Cardiachierarchy wereⅠgrade 9 cases,Ⅱgrade 16 cases,Ⅲgrade 5 cases.In additon,9 cases of death were selected as a group for evaluation of the curative effect of operation. Every patient was underwent MRI and UCG exam before operation and twelve patients rechecked with MRI and UCG postoperation within one week to one month.Besides,30 healthy volunteers were set as control group,15 males and 15 females age from 3 years to 31 years,mean age 22.7 years,BSA were 1.34m~2～1.84m~2,average 1.57±0.27m~2.All of them were underwent MRI exam for contrast.2.Methods:MRI equipment was Signa 1.5T superconduct scanner produced by American GE company with phase array coil.UCG facility was HP Sonos 5500 and HP Sonos 7500 ultrasound scanner producted by American HP company.The frequence of detector S4 was 2.0～4.0 MHz, frequence of detector S3 was 1.0～3.0 MHz.MRI scan steps:(1)First used real time loc techqiue to get the standard left ventricular long axial plane.(2)then scaned the standard short axial plane of left ventricle with FIESTA sequence.(3) then image data were disposed in GE ADW4.2 workstation with cardiac function analysis softwares(Mass analysis).Result come out in the format of text.3.Study items:(1)Calculated the cardiacfunctional indexs preoperation and made a contrast with postoperation.(2)Analysised the correlativity of results tested by MRI and UCG respectively.Results:(1)Results tested preoperation indicated:LVEDV,RVEDV in TOF group were significantly smaller than that in control group(P＜0.05)but the EF in TOF group was much higher(P＜0.05).In contrast with UCG,we found that LVEDV and LVEF have positive correlativity with UCG(rlvedv=0.78, rlvef=0.80,P＜0.05).but we had not found any correlativity in LVCO.Grouped with the cardiac chierarchy,we found positive correlativity between clinic cardiac chierarchy and heart function parameters tested by MRI.In nine cases of death,we found that the RVCO in mortal group were greatly lower than that in survival group(P＜0.05).(2)Results after operation:LVEDV,LVCO,RVEDV, and RVCO increased obviously(P＜0.1).There was not significant difference in the ventricular function between the pulmonary backstreaming group and the group without pulmonary backstreaming.Conclusions:(1)MRI was an sensitive,reliable procedure for evalution of ventricular function.(2)EDV,EF,CO were available indexs for evaluation of cardiac function.(3)following up right ventricular function with MRI could help medical management postoperation.