TY - JOUR
T1 - Cardiac Magnetic Resonance to Predict Coronary Artery Compression in Transcatheter Pulmonary Valve Implantation Into Conduits
AU - Romans, Ryan A.
AU - Lu, Jimmy C.
AU - Balasubramanian, Sowmya
AU - Whiteside, Wendy
AU - Yu, Sunkyung
AU - Aldoss, Osamah T.
AU - Armstrong, Aimee K.
AU - Boe, Brian A.
AU - Balzer, David T.
AU - Christensen, Jason T.
AU - Jones, Thomas K.
AU - Keeshan, Britton
AU - McLennan, Daniel
AU - Nicholson, George T.
AU - Patel, Neil
AU - Salavitabar, Arash
AU - Shahanavaz, Shabana
AU - Sullivan, Patrick M.
AU - Turner, Mariel E.
AU - Zampi, Jeffrey D.
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/5/9
Y1 - 2022/5/9
N2 - Objectives: The aim of this study was to evaluate the accuracy of cardiac magnetic resonance (CMR) in predicting coronary artery (CA) compression during transcatheter pulmonary valve implantation (TPVi). Background: TPVi is a widely available option to treat dysfunctional right ventricle (RV)–to–pulmonary artery (PA) conduits, but CA compression is an absolute contraindication. CMR can evaluate coronary anatomy, but its utility in predicting CA compression is not well established. Methods: After Institutional Review Board approval was obtained, all patients at 9 centers with attempted TPVi in RV-PA conduits and recent CMR (≤12 months) were analyzed. A core laboratory reviewed all CMR studies for the shortest orthogonal distance from a CA to the conduit, the shortest distance from a CA to the most stenotic area of the conduit, and subjective assessment of CA compression risk. Results: Among 231 patients, TPVi was successful in 198 (86%); in 24 (10%), balloon testing precluded implantation (documented CA compression or high risk). Distance to the RV-PA conduit ≤2.1 mm (area under the curve [AUC]: 0.70) and distance to most stenotic area ≤13.1 mm (AUC: 0.69) predicted CA compression. Subjective assessment had the highest AUC (0.78), with 96% negative predictive value. Both distances and qualitative assessment remained independently associated with CA compression when controlling for abnormal coronary anatomy or degree of conduit calcification. Conclusions: CMR can help predict the risk for CA compression during TPVi in RV-PA conduits but cannot completely exclude CA compression. CMR may assist in patient selection and counseling families prior to TPVi, although balloon testing remains essential.
AB - Objectives: The aim of this study was to evaluate the accuracy of cardiac magnetic resonance (CMR) in predicting coronary artery (CA) compression during transcatheter pulmonary valve implantation (TPVi). Background: TPVi is a widely available option to treat dysfunctional right ventricle (RV)–to–pulmonary artery (PA) conduits, but CA compression is an absolute contraindication. CMR can evaluate coronary anatomy, but its utility in predicting CA compression is not well established. Methods: After Institutional Review Board approval was obtained, all patients at 9 centers with attempted TPVi in RV-PA conduits and recent CMR (≤12 months) were analyzed. A core laboratory reviewed all CMR studies for the shortest orthogonal distance from a CA to the conduit, the shortest distance from a CA to the most stenotic area of the conduit, and subjective assessment of CA compression risk. Results: Among 231 patients, TPVi was successful in 198 (86%); in 24 (10%), balloon testing precluded implantation (documented CA compression or high risk). Distance to the RV-PA conduit ≤2.1 mm (area under the curve [AUC]: 0.70) and distance to most stenotic area ≤13.1 mm (AUC: 0.69) predicted CA compression. Subjective assessment had the highest AUC (0.78), with 96% negative predictive value. Both distances and qualitative assessment remained independently associated with CA compression when controlling for abnormal coronary anatomy or degree of conduit calcification. Conclusions: CMR can help predict the risk for CA compression during TPVi in RV-PA conduits but cannot completely exclude CA compression. CMR may assist in patient selection and counseling families prior to TPVi, although balloon testing remains essential.
KW - cardiac magnetic resonance
KW - congenital heart disease
KW - transcatheter pulmonary valve implantation
UR - http://www.scopus.com/inward/record.url?scp=85129371959&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2022.02.047
DO - 10.1016/j.jcin.2022.02.047
M3 - Article
C2 - 35512922
AN - SCOPUS:85129371959
SN - 1936-8798
VL - 15
SP - 979
EP - 988
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 9
ER -