Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
Opere Fallot Tetralojisi Hastalarında Kardiyak Manyetik Rezonans Görüntüleme ve Manyetik Rezonans Anjiyografi Bulguları
Cardiac Magnetic Resonance Imaging and Magnetic Resonance Angiography in Surgically Corrected Tetralogy of Fallot Patients
Hasan YİĞİTa, Elif ERGÜNa, Pınar Nercis KOŞARa
aRadyoloji Kliniği, Ankara Eğitim ve Araştırma Hastanesi, Ankara, TÜRKİYE
Turkiye Klinikleri J Cardiovasc Sci. 2019;31(1):10-20
doi: 10.5336/cardiosci.2018-64374
Article Language: TR
Full Text
ÖZET
 Amaç: Cerrahi olarak tam düzeltme uygulanmış fallot tetralojisi hastalarında kardiyak MRG ve MR anjiyografi bulgularının ortaya konmasıdır. Gereç ve Yöntemler: 1.5 Tesla MR sistemlerinde opere fallot tetralojisi tanısıyla kardiyak MRG ve MR anjiyografi incelemesi gerçekleştirilmiş hastalar görüntüleme arşivinden tarandı ve tanısal iş istasyonlarında değerlendirildi. Bulgular: Yaş aralığı 7 ile 50 yıl olan 82 hasta çalışmaya dâhil edildi. En sık görüntüleme bulguları pulmoner yetmezlik (%97,8), sağ ventrikül sistol ve diyastol sonu hacim artışı (sırasıyla %92,7 ve %89) ve trabekülasyon artışı (%91,5) idi. Sağ ventrikül çıkış yolunda akinezi/diskinezi hastaların 75,6'sında görülürken, %59,8'inde sağ ventrikül çıkış yolunda dilatasyon kaydedildi. Sağ aortik ark (%31,7), aberan sağ subklavyen arter (%4,9) ve uzamış transvers aortik ark (%1,2) gibi aortik anomalilerin yanı sıra santral venöz anomaliler de (%7,3) saptandı. Geç kontrastlı görüntüleme gerçekleştirilen hastalar (%40,2)'ın %51,5'inde sağ ventrikül çıkış yolunda fibröz lehine kontrastlanmalar ve %78,8'inde interventriküler septumda/sol ventrikül duvarlarında noniskemik özellikte kontrastlanmalar izlenmiştir. İnterventriküler septumda paradoks hareket, sağ kalp boşluklarında genişleme, triküspid kapakta yetmezlik, pulmoner stenoz, pulmoner arterlerde genişleme, sağ ventrikül sistolik disfonksiyonu, sol ventrikül hacim artışı diğer sık rastlanılan bulguları oluşturmaktadır. Sonuç: Opere fallot tetralojisi hastalarında en sık görülen MRG bulgusu pulmoner yetmezlik olup; MRG ile yetmezlik kantifikasyonu yapılmakta, ayrıca ventrikül fonksiyonları ortaya konarak geri dönüşsüz sağ kalp yetersizliği gelişmeden önce kapak replasmanına yönelik uygun zamanlama için değerli bir veri sağlanmaktadır. Bununla sınırlı olmayarak; kardiyak MRG ve MR anjiyografi, kardiyak morfoloji, fonksiyon, miyokardiyal canlılık ve vasküler anatomiyi ortaya koyarak bu hastalarda çok kapsamlı, multiparametrik değerlendirme olanağı sunmaktadır.

Anahtar Kelimeler: Fallot tetralojisi; manyetik rezonans görüntüleme; manyetik rezonans anjiyografi
ABSTRACT
 Objective: To define the MRI and MR angiography findings in patients with total surgical correction of tetralogy of fallot (TOF). Material and Methods: Patients who underwent cardiac MRI and MR angiography due to surgically corrected TOF are retrieved from PACS (Picture Archiving and Communication System) and evaluated on diagnostic work stations. Results: 82 patients (age range: 7-50) were included. The most common imaging findings were pulmonary insufficiency (97.8%), increase in right ventricle end diastolic and end systolic volume (92.7% and 89% respectively) and right ventricle trabeculation (91.5%). Akinesia/dyskinesia of right ventricle outflow tract (RVOT) was seen in 75.6% while 59.8% had RVOT dilatation. In addition to aortic anomalies like right aortic arc (31.7%), aberrant right subclavian artery (4.9%) and elongated transverse aortic arc (1.2%) central venous anomalies (7.3%) were also observed. Among the patients in whom delayed enhancement was performed (40.2%), 51.5% had late enhancement in RVOT and 78.8% had nonischemic type late enhancement in interventricular septum/left ventricle wall. Paradoxical motion of the interventricular septum, dilatation of right heart chambers, tricuspid insufficiency, pulmonary stenosis, dilatation of pulmonary arteries, systolic dysfunction of right ventricle, increase in left ventricular volume were other common findings. Conclusion: The most common cardiac MRI finding in surgically corrected fallot tetralogy is pulmonary insufficiency which can be correctly detected and quantified by MRI. In addition, determining the functional status of right ventricle helps optimal timing of surgery before irreversible right ventricular insufficiency occurs. MRI and MR angiography provides multiparametric evaluation including morphological and functional analysis, myocardial viability, vascular anatomy.

Keywords: Tetralogy of fallot; magnetic resonance imaging; magnetic resonance angiography
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