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Magnetic Resonance Imaging Evaluation of Surgical Ventricular Reconstruction
IMAGES IN CARDIOTHORACIC SURGERY
Magnetic Resonance Imaging Evaluation of Surgical Ventricular Reconstruction Shunsuke Natori, MD, PhD, John V. Conte, MD, João A. C. Lima, MD, and David A. Bluemke, MD, PhD
Fig 2.
Fig 1.
T
he patient is a 49-year-old male who had a massive anterior myocardial infarction due to an obstruction of the left anterior descending artery in July 2002. He also had sudden onset of speech disturbance, left arm tingling, and a right facial droop after his infarction. He was diagnosed with thromboembolic cerebrovascular attack secondary to a mural thrombus in the left ventricle. His stroke symptoms resolved, and he was admitted for cardiac surgery. Cardiac catheterization showed severe two-vessel coronary artery disease, and a left ventriculogram showed massive anterior aneurysm. Preoperative cardiac magnetic resonance imaging revealed a massive mural thrombus in the left ventricle. Short axis cine image (Fig 1, top row) showed thinning of the left ventricle. Cine images are acquired using an electrocardiographic-gated steady state free precession pulse sequence. Smooth, regular mural thrombus with low signal was well demonstrated from the anterior wall at the base extending circumferentially at the apex. Myocardial viability image delayed enhancement magnetic resonance images after injection of gadodiamide contrast (Fig 1, lower row) showed the extent of a hyperenhancing myocardial scar (nonviable) from the anterior wall at the base becoming circumferential at the apex (arrows). Viability Address reprint requests to Dr Bluemke, Johns Hopkins University School of Medicine, Radiology and Radiological Science, 600 N Wolfe St/MRI 143, Baltimore, MD 21287-6953; e-mail: [email protected].
© 2005 by The Society of Thoracic Surgeons Published by Elsevier Inc
Table 1. Left Ventricular Function Before and After Surgical Ventricular Reconstruction
Left ventricular volume (mL) Left ventricular volume (mL) Left ventricular volume (mL) Left ventricular fraction (%)
Preoperative
Postoperative
end-diastolic
817
255
end-systolic
742
147
75
108
9
42
stroke ejection
images were obtained 10 to 15 minutes after contrast injection by using an inversion-recovery prepared gated fast-gradient echo-planar sequence. Viable myocardium and thrombus were not enhanced (Fig 1). The left ventricular ejection fraction was 9%. The left ventricular end-diastolic volume was 817 mL and the end-systolic volume was 742 mL (Table 1). The patient underwent two-vessel coronary bypass surgery and surgical ventricular reconstruction. The postoperative cardiac magnetic resonance image showed a significant decrease in left ventricular volume (Fig 2, short axis image [left] and 3-chamber view [right]) and improvement of the ejection fraction to 42%. Cardiac magnetic resonance imaging is a useful tool for surgical planning and provides accurate information about aneurysm extent and myocardium viability.
Ann Thorac Surg 2005;80:743 • 0003-4975/05/$30.00 doi:10.1016/j.athoracsur.2003.09.094
FEATURE ARTICLES
Russell H. Morgan Department of Radiology and Radiological Science, Department of Surgery, Division of Cardiac Surgery, and Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
Magnetic Resonance Imaging Evaluation of Surgical Ventricular Reconstruction Shunsuke Natori, MD, PhD, John V. Conte, MD, João A. C. Lima, MD, and David A. Bluemke, MD, PhD
Fig 2.
Fig 1.
T
he patient is a 49-year-old male who had a massive anterior myocardial infarction due to an obstruction of the left anterior descending artery in July 2002. He also had sudden onset of speech disturbance, left arm tingling, and a right facial droop after his infarction. He was diagnosed with thromboembolic cerebrovascular attack secondary to a mural thrombus in the left ventricle. His stroke symptoms resolved, and he was admitted for cardiac surgery. Cardiac catheterization showed severe two-vessel coronary artery disease, and a left ventriculogram showed massive anterior aneurysm. Preoperative cardiac magnetic resonance imaging revealed a massive mural thrombus in the left ventricle. Short axis cine image (Fig 1, top row) showed thinning of the left ventricle. Cine images are acquired using an electrocardiographic-gated steady state free precession pulse sequence. Smooth, regular mural thrombus with low signal was well demonstrated from the anterior wall at the base extending circumferentially at the apex. Myocardial viability image delayed enhancement magnetic resonance images after injection of gadodiamide contrast (Fig 1, lower row) showed the extent of a hyperenhancing myocardial scar (nonviable) from the anterior wall at the base becoming circumferential at the apex (arrows). Viability Address reprint requests to Dr Bluemke, Johns Hopkins University School of Medicine, Radiology and Radiological Science, 600 N Wolfe St/MRI 143, Baltimore, MD 21287-6953; e-mail: [email protected].
© 2005 by The Society of Thoracic Surgeons Published by Elsevier Inc
Table 1. Left Ventricular Function Before and After Surgical Ventricular Reconstruction
Left ventricular volume (mL) Left ventricular volume (mL) Left ventricular volume (mL) Left ventricular fraction (%)
Preoperative
Postoperative
end-diastolic
817
255
end-systolic
742
147
75
108
9
42
stroke ejection
images were obtained 10 to 15 minutes after contrast injection by using an inversion-recovery prepared gated fast-gradient echo-planar sequence. Viable myocardium and thrombus were not enhanced (Fig 1). The left ventricular ejection fraction was 9%. The left ventricular end-diastolic volume was 817 mL and the end-systolic volume was 742 mL (Table 1). The patient underwent two-vessel coronary bypass surgery and surgical ventricular reconstruction. The postoperative cardiac magnetic resonance image showed a significant decrease in left ventricular volume (Fig 2, short axis image [left] and 3-chamber view [right]) and improvement of the ejection fraction to 42%. Cardiac magnetic resonance imaging is a useful tool for surgical planning and provides accurate information about aneurysm extent and myocardium viability.
Ann Thorac Surg 2005;80:743 • 0003-4975/05/$30.00 doi:10.1016/j.athoracsur.2003.09.094
FEATURE ARTICLES
Russell H. Morgan Department of Radiology and Radiological Science, Department of Surgery, Division of Cardiac Surgery, and Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland