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Anomalies of the Right Ventricular Outflow Tract and Pulmonary Arteries

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MRI of Cardiovascular Malformations

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Abstract

MRIis the best non-invasive imaging method to depict the right ventricular outflow tract, pulmonary artery trunk (retrosternal) and left and right branches (situated more posteriorly) due to its multislice (sagittal, axial, oblique, etc.) approach, its large field of view and the absence of gas or bone artefacts which hinder US examination. MRI is currently used for the preoperative and postoperative assessment of certain forms of cyanotic heart disease. The different pulmonary artery malformations can be assessed by MRI and these include unilateral absence of pulmonary artery (UAPA), truncus arteriosus, anomalus left pulmonary artery, valvular pulmonary atresia, valvular pulmonary stenosis and pulmonary artery stenosis and atresia. Each entity has special MR imaging characteristics. Cyanotic heart disease corresponds to a group of anomalies secondary to the presence of a right-left shunt. Cyanosis is the essential clinical feature with a variable expression according to the disease. MRI images are perfectly adapted to analyse the main anomalies affecting the right ventricular outflow tract. These include tetralogy of Fallot, pulmonary atresia with ventricular septal defect, pulmonary atresia with intact interventricular septum, transposition of the great vessels, double outlet right ventricle, double outlet left ventricle, single ventricle, tricuspid atresia and Ebstein anomaly. Each of these entities has special cardinal MRI features.

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Notes

  1. 1.

    Particularly in the case of pulmonary artery atresia or nonconfluence of the right and left branches.

  2. 2.

    A major coronary branch crossing anteriorly over the pulmonary infundibulum can be situated in the zone of incision during enlargement of the right ventricular outflow tract (for infundibular stenosis) (see Chap. 8, Fig. 8.29).

  3. 3.

    Superior vena cava and inferior vena cava ® morphologically right atrium ® morphologically right ventricle ® aorta ® systemic circulation ® superior vena cava and inferior vena cava

    Pulmonary veins ® morphologically left atrium ® morphologically left ventricle ® pulmonary artery ® pulmonary circulation ® lung ® pulmonary veins.

  4. 4.

    The term “double discordance” is now preferred to “corrected transposition.”

  5. 5.

    Superior vena cava and inferior vena cava ® morphologically right atrium ® morphologically left ventricle ® pulmonary artery ® pulmonary circulation ® lung ® pulmonary vein ® morphologically left atrium ® morphologically right ventricle ® aorta ® systemic circulation ® superior vena cava and inferior vena cava.

  6. 6.

    The terms malposition and transposition, which concern the respective positions of the great vessels at their origin, were discussed in Chap. 3.

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Authors and Affiliations

  1. Service de Radiologie A et C, Centre Hospitalier Universitaire Jean Minjoz, bd. Alexander Fleming, 25000, Besançon, France

    Bruno Kastler (Professor of Radiology and Head of Radiology, Associate Professor of Radiology)

  2. Director of Laboratoire I4S (Health, Innovation, Intervention, Imaging, Engineering), Université de Franche-Comté, Besançon, France

    Bruno Kastler (Professor of Radiology and Head of Radiology, Associate Professor of Radiology)

  3. Department of Radiology, Centre Hospitalier Universitaire, Sherbrooke, Québec, Canada

    Bruno Kastler (Professor of Radiology and Head of Radiology, Associate Professor of Radiology)

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Kastler, B. (2011). Anomalies of the Right Ventricular Outflow Tract and Pulmonary Arteries. In: MRI of Cardiovascular Malformations. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-30702-0_7

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