Advanced imaging and intervention in congenital heart disease

Evangeline Warmerdam

Research output: ThesisDoctoral thesis 1 (Research UU / Graduation UU)

40 Downloads (Pure)

Abstract

The increased survival of CHD patients means this patient group will continue to grow,
and physicians will be confronted with novel long-term complications. Innovation in
the field of diagnostics and interventions for CHD is therefore crucial. In this thesis,
we investigate the role of 4D flow CMR and several different percutaneous treatment
strategies for CHD.

There are several reasons why 4D flow CMR is ideally suited for haemodynamic
evaluation in CHD patients. First, it is a non-invasive modality and does not require
the administration of iodinated contrast. This means the burden for the patient is low,
which is important when there is a need for lifelong follow-up. Second, the ability of
retrospective valve-tracking eliminates through-plane motion of the valve, making 4D
flow CMR superior to 2D PC CMR in evaluating valvular flow, as we report in chapter 7.
Regurgitation fraction and peak gradient (calculated from peak velocity) are important
indicators in evaluating the need for valve replacement. It is therefore crucial to have
serial measurements that are as precise as possible. Third, the ability to analyse a
complete volume and retrospectively identify an area of interest compared to analysing
single pre-defined planes is a great advantage and leads to a more accurate analysis
of the blood flow, as we see in chapter 8. Finally, the fact that 4D flow CMR acquires a complete volume instead of a single plane, means that it can provide a wide range of advanced flow parameters, such as wall shear stress, energy loss and vorticity. As is the case with all novel imaging parameters, the clinical significance of these parameters needs to be investigated.

In the last decades, the scope of percutaneous interventions for CHD has widened to
include valve replacement, stent placement for relief of arterial stenosis, closure of
collateral vessels and closure of septal defects. In the future, we expect the scope to
widen even further to the development of novel stents and devices. Evidence for the
safety and efficacy of most percutaneous interventions for CHD is limited, even for
procedures that are widely accepted and often performed.The
reasons for this lack of evidence are clear: CHD is a relatively small group within the
population of cardiovascular disease and it is a heterogenous population. However, this
does not mean the need for evidence-based medicine is somehow less in this patient
group, or that novel treatment strategies do not require thorough evaluation. Obviously,
retrospective single-centre studies (as presented in this thesis) will not solve this issue.
They can, however, be a first step towards a multicentre or national collaboration
to investigate treatment strategies. In the future, more prospective, protocolized
multicentre research is warranted for treatment of CHD and academic medical centres
should initiate this research and collaborate to ultimately provide optimal care for the
growing group of CHD patients.
Original languageEnglish
Awarding Institution
  • University Medical Center (UMC) Utrecht
Supervisors/Advisors
  • Doevendans, Pieter, Primary supervisor
  • Leiner, Tim, Supervisor
  • Voskuil, Michiel, Co-supervisor
  • Grotenhuis, Heynric, Co-supervisor
Award date26 Aug 2021
Publisher
Print ISBNs978-94-6416-345-2
DOIs
Publication statusPublished - 26 Aug 2021

Keywords

  • Congenital heart disease
  • 4D flow CMR
  • cardiac magnetic resonance
  • coarctation of the aorta
  • transposition of the great arteries
  • tetralogy of fallot

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