Is MRI the Preferred Method for Evaluating Right Ventricular Size and Function in Patients With Congenital Heart Disease?Response to Defaria Yeh and Foster
MRI Is Not the Preferred Method for Evaluating Right Ventricular Size and Function in Patients With Congenital Heart Disease
Because of major advances in congenital heart surgery and intensive care during the past 60 years, the number of adults living with congenital heart disease (CHD) has risen sharply. Currently, in the United States, there are more adults living with CHD than children.1 The estimated prevalence of adult congenital heart disease (ACHD) is ≈3000 per million adults,2 and this number is expected to increase by 5% per year.3 The late sequelae associated with surgical and nonsurgical palliation include valvular degeneration and regurgitation, ventricular systolic and diastolic dysfunction, and arrhythmias. For the vast majority of patients with moderate-to-complex congenital heart disease, serial cardiovascular imaging is required to monitor structural changes to determine need and timing of repeat intervention.
Response by Geva see p 205
In many patients with CHD, the right heart is most affected. Despite life-saving palliation, the right ventricle (RV) may experience persistent pressure or volume overload, and there may be intrinsic RV myopathy or processes that result in the RV functioning as the systemic or subaortic ventricle (Table 1). It has been demonstrated that patients with RV enlargement, dysfunction, and fibrosis have greater exercise limitation and are at risk for RV failure and lethal ventricular arrhythmias.4 There is a trend to recommend earlier reintervention to preserve RV function and decrease risk of chronic right heart failure.5 Careful quantification of RV size and function is critical in determining optimal timing of catheter-based intervention or surgical correction.
During the past decade, there have been many advances in noninvasive RV imaging. Echocardiography, cardiac computed tomographic angiography (CTA), and cardiac magnetic resonance (CMR) are the modalities of choice for evaluating the RV, each with unique advantages and short falls. CMR is currently the gold standard for quantifying RV function in patients …