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2 results

  • Cardiac magnetic resonance haemodynamics in paediatric heart transplant patients: fick oximetry versus cardiac magnetic resonance phase contrast

  • Jennifer Schramm, Ileen Cronin, Robert McCarter, Jason G. Mandell, Tacy Downing, Joshua Kanter, Russell Cross, Laura Olivieri
  • Journal:
    Cardiology in the Young / Volume 34 / Issue 2 / February 2024
    Published online by Cambridge University Press:
    15 June 2023, pp. 262-267
    • Article
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  • Background:

    Lifetime radiation exposure for paediatric orthotopic heart transplant (OHT) patients is significant with cardiac catheterisation as the dominant source. Interventional cardiac magnetic resonance is utilised to obtain simultaneous, radiation-free haemodynamics and flow/function measurements. We sought to compare invasive haemodynamic measurements and radiation exposure in traditional cardiac catheterisation, to comprehensive interventional cardiac magnetic resonance.

    Methods:

    Twenty-eight OHT patients who underwent 67 interventional cardiac magnetic resonance procedures at Children’s National Hospital were identified. Both invasive oximetry with peripheral oxygen saturation (Fick) and cardiac magnetic resonance phase contrast measurements of pulmonary and systemic blood flow were performed. Systemic and pulmonary blood flow from the two modalities was compared using Bland–Altman, concordance analysis, and inter-reader correlation. A mixed model was implemented to account for confounding variables and repeat encounters. Radiation dosage data were collected for a contemporaneous cohort of orthotopic heart transplant patients undergoing standard, X-ray-guided catheterisation.

    Results:

    Simultaneous cardiac magnetic resonance and Fick have poor agreement in our study based on Lin’s correlation coefficient of 0.68 and 0.73 for pulmonary and systemic blood flow, respectively. Bland–Altman analysis demonstrated a consistent over estimation of cardiac magnetic resonance cardiac output by Fick. The average indexed dose area product for patients undergoing haemodynamics with endomyocardial biopsy was 0.73 (SD ±0.6) Gy*m2/kg. With coronary angiography added, the indexed dose area product was 14.6 (SD ± 7.8) Gy*m2/kg.

    Conclusions:

    Cardiac magnetic resonancemeasurements of cardiac output/index in paediatric orthotopic heart transplant patients have poor concordance with Fick estimates; however, cardiac magnetic resonance has good internal validity and inter-reader reliability. Radiation doses are small for haemodynamics with biopsy and increase exponentially with angiography, identifying a new target for cardiac magnetic resonance imaging.

  • Chapter 22 - Living donor liver transplantation

  • from Section 4 - Liver
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 182-189

  • Summary

    Heart transplantation remains the only realistic therapeutic option for children with end-stage heart disease. The main indication for transplantation in children is severe heart failure (HF) associated with impaired function of the systemic ventricle. Extensive evidence supports the use of cardiopulmonary exercise testing to select patients with increased short-term mortality who should be offered transplantation. Transplantation for congenital heart disease illustrates best many of the peculiarities of heart transplant in the pediatric age group. The assessment of pulmonary vascular resistance (PVR) is particularly crucial in order to reduce the rate of right HF post-transplant, but it can be technically difficult, particularly in congenital heart disease. Maintenance therapy is commonly a combination of a calcineurin inhibitor (CNI) and cell cycle inhibitor. A problem in pediatric transplantation is the presence of pre-existing human leukocyte antigen (HLA) antibodies, which have been linked to increased hyperacute, cellular, and humoral rejection and increased mortality posttransplant.