Spin echo MRI in the evaluation of hearts with a double outlet right ventricle: usefulness and limitations

The surgical approach to a double outlet right ventricle (DORV) is dependen t on the spatial relationship of the semilunar valves, outflow tracts and v entricular septal defect (VSD). The purpose of the study was to assess the value of MRI for the evaluation of cardiovascular anatomy in patients befor e and after surgery for DORV. Spin echo MRI was performed in 12 patients wi th DORV (eight preoperative and four postoperative patients). Thin-section MRI was performed in three orthogonal planes and selected angulated views w ere obtained. Conventional imaging by color Doppler echocardiography and ci ne-angiocardiography and surgical findings, when present, served as the ref erence standards. The results found that the spatial relationship between s emilunar valves and VSD was accurately assessed by MRI in eight out of eigh t preoperative patients. In the four postoperative cases MRI depicted the m orphology of both outflow tracts and provided adequate information on their patency. Of the eight preoperative patients, five have undergone correctiv e surgery and the MRI findings were confirmed. MRI provided additional info rmation to conventional imaging preoperatively in three cases in which the VSD opened into the outlet portion of the DORV, without there being a direc t relation to a semilunar valve. In two preoperative cases in which the VSD was directly committed to the aorta, conventional imaging was conclusive. MRI was unable to depict aberrant chordae tendineae in four out of four cas es. We conclude that MRI provides accurate additional anatomic information in patients with DORV, which is helpful in presurgical planning as well as during follow-up. Spin echo MRI does not visualize aberrant chordae tendine ae. (C) 2000 Elsevier Science Inc. All rights reserved.