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  • Poster presentation
  • Open Access

Cine acquisition strategies for visualizing atrial septal defects by CMR

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  • 1,
  • 1,
  • 1 and
  • 1
Journal of Cardiovascular Magnetic Resonance201315 (Suppl 1) :P286

https://doi.org/10.1186/1532-429X-15-S1-P286

  • Published:

Keywords

  • Cardiovascular Magnetic Resonance
  • Atrial Septal Defect
  • Cardiovascular Magnetic Resonance Study
  • Short Axis Cine
  • Ostium Secundum

Background

Atrial septal defects (ASDs) may escape detection before adulthood, particularly those in unusual locations, which may elude echocardiographic visualisation. CMR is established for the quantification of shunt flow and, if appropriately acquired, can provide clear visualisation of ASDs and adjacent structures to inform decisions regarding intervention. Our objective is to recommend cardiovascular magnetic resonance (CMR) cine acquisition strategies suitable for the visualisation of the less common as well as the common types of ASD.

Methods

In the CMR Unit of a tertiary referral centre for adults with congenital heart disease we retrospectively reviewed the CMRs of patients with unoperated ASDs over a 3 year period to assess the suitability of cine acquisition strategies for the visualisation of different types of ASD and any associated anomalies of pulmonary venous connection.

Results

157 patients with unoperated ASDs had CMR studies in 3 years. If already suspected, we had routinely acquired an ‘atrial stack' of cines, meaning a contiguous stack, 5mm thick, parallel to the routine ventricular short axis (SA) stack, stepping backward from the basal ventricular plane until the superior vena cava was identifiable. This orientation visualized ostium secundum ASDs well (n=117), and was also good for inferior sinus venosus defects (n=2) and unroofed coronary sinus (n=3). In superior sinus venosus defects (n=21), a transaxial cine stack was found to give clearer visualisation of both the defect and any associated anomalous pulmonary vein connection(s) (n=20, plus 4 anomalous connections identified with secundum ASDs). The transaxial cine orientation was also the more suitable one for atrio-ventricular septal defects (AVSD, n=15) as it depicted insertions of the A-V valve leaflets adjacent to the defect(s).

Conclusions

In patients with suspected ASDs, we recommend the acquisition of an atrial SA cine stack and a transaxial cine stack that covers atrial to aortic arch levels. Additional oblique cines aligned with the defect can supplement these, as indicated in the table.
Table 1

Cine orientations for visualizing atrial septal defects and anomalous pulmonary veins.

 

Atrial short axis stack

Transaxial stack

Additional oblique planes

Ostium secundum defect

Good

Satisfactory

4-chamber cine

Superior sinus venosus defect

Satisfactory

Good

3-chamber cine

Atrioventricular septal defect

Suboptimal

Good

4-chamber cine

Unroofed coronary sinus

Good

Suboptimal

Consider whether the coronary sinus roof is visible in all long axis cines

Inferior sinus venosus defect

Good

Suboptimal

Oblique sagittal cine

Anomalous pulmonary veins

Suboptimal

Good

Oblique coronal cine

Funding

None

Authors’ Affiliations

(1)
CMR Unit, Royal Brompton Hospital, London, UK, London, UK

Copyright

© Natarajan et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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