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J Thorac Cardiovasc Surg 2007;133:676-681
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Delayed-enhancement cardiovascular magnetic resonance identifies fibrous tissue in children after surgery for congenital heart disease

^a Department of Pediatrics, Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pa
^b Department of Pediatrics, Section of Pediatric Cardiology, J.W. Riley Hospital for Children, Philadelphia, Pa.

Received for publication July 31, 2006; revisions received October 4, 2006; accepted for publication October 16, 2006.

^_* Address for reprints: Matthew Harris, MD, Assistant Professor of Pediatrics and Radiology, Divisions of Cardiology and Cardiac MRI, The Children’s Hospital of Philadelphia and the University of Pennsylvania, Office Suite 2205—Main Building, Philadelphia, PA 19103 (Email: harrismat{at}email.chop.edu).

Objectives: To determine whether delayed-enhancement magnetic resonance imaging can identify fibrous tissue associated with patch reconstructions in postoperative patients with congenital heart disease. Additionally, to determine whether fibrous structures not directly related to the surgical reconstruction exhibited delayed enhancement.

Methods: Seventy-three patients underwent magnetic resonance imaging. Studies were retrospectively reviewed for the presence of delayed enhancement along the ventricular outflow tracts, cardiac valves, and where available, the ascending aorta. Three groups were identified. Group A patients (n = 34) underwent right ventricular outflow tract reconstruction and ventricular septal defect patch closure. Group B patients (n = 33) had never undergone cardiac surgery. Group C patients (n = 6) had functional single ventricle and underwent Norwood reconstruction.

Results: In group A, 31 of 34 patients had delayed enhancement of the right ventricular outflow tract, and 14 of 34 had delayed enhancement of the ventricular septal defect patch (P < .001). In group B (n = 33), 1 patient with arrhythmogenic right ventricular dysplasia had delayed enhancement limited to the right ventricular outflow tract. The remainder had no delayed enhancement of either outflow tract. Delayed enhancement of the aortic valve and ascending aorta was observed in 13 of 34 (P = .002) and 10 of 26 (P = .05) group A patients, respectively, compared with 2 of 33 and 3 of 24 group B patients. In group C, delayed enhancement of the Norwood reconstruction was observed in 5 of 6 patients (P = .002).

Conclusions: Delayed-enhancement imaging detects fibrous tissue along regions of reconstruction in patients who have had surgery for congenital heart disease. Furthermore, delayed-enhancement imaging detects fibrous tissue in regions not directly related to the reconstructive surgery, including cardiac valves and the wall of the ascending aorta.

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