Rapid Fire Abstracts
Makenzie Whalen, N/A
Medical Student
Medical College of Wisconsin
Scott Cohen, MD
Medical College of Wisconsin
Stacy Leibham, BSc, RT
Lead MRI technician
Childrens Wisconsin
Salil Ginde, MD, MPH
Associate Professor
Medical College of Wisconsin, Children's Wisconsin
Matthew Buelow, MD
Associate Professor
Medical College of Wisconsin, Children's Wisconsin
Bradley Johnson, MD
Assistant Professor
Medical College of Wisconsin , Children's Wisconsin
Peter Bartz, MD
Professor
Medical College of Wisconsin, Children's Wisconsin
Jennifer Gerardin, MD
Associate Professor
Medical College of Wisconsin, Children's Wisconsin
Due to gaps in care, many women with adult congenital heart disease (ACHD) may not be up to date on recommended advanced imaging prior to pregnancy, which also may impact peri-partum care. Our aim is to look at the utility of CMR in pregnant ACHD patients.
Methods:
This is a case series of 12 consecutive ACHD patients who had a CMR during pregnancy since 2018. All CMRs were performed without contrast per institutional protocol on a 3 Tesla scanner. One scan was performed on a 1.5 Tesla scanner due to a pacemaker. Data collected included general demographics, timing of CMR, and whether the CMR affected the location, timing, or mode of delivery. The newborn charts were reviewed for adverse neonatal events including newborn hearing screens.
Results:
The mean age was 30 ± 8 years, and all patients had modified WHO classification of II-IV. 83% of women had no prior advanced imaging prior to pregnancy. The first CMR was performed at mean 22 5/7 ± 4 5/7 weeks gestation (Table 1). CMRs lasted a mean of 37 ± 8 minutes. Nine women had one CMR, and three women had more than one CMR during pregnancy. The repeat imaging was used to evaluate aneurysms and for chronic dissection progression during pregnancy (Figure 1). Most women (83%) had an aortopathy or prior coarctation of the aorta. For these women, an aortic arch cine was performed with perpendicular cine stack through any aneurysm or narrowing (Figure 2). Two patients were found to have new aneurysms or pseudoaneurysms on their CMRs. Two of the three women with repeat CMRs needed interventions on their aortas in the post-partum period. CMRs influenced peri-partum care for 75% women. Only 58% of patients delivered after 36 weeks. There were no adverse maternal or neonatal outcomes related to the CMR.
Conclusion:
CMRs are feasible and safe during pregnancy in ACHD patients on a 3T scanner. Ideally, this imaging should be performed in the early second trimester to improve patient comfort and safety since patients are supine for 30-40 minutes. CMR examinations should be tailored to answer a specific question. Non-contrast CMR results affected the mode of delivery, timing and location of delivery. The high rate of preterm delivery was most likely related to the complexity of the cohort’s cardiac pathology. However, patients should ideally aim to have continuous follow up with an ACHD specialist and recommended CMR completed before pregnancy.
Double oblique sagittal gradient echo cine of the aortic arch in a 41 year old with a chronic type B dissection of the aorta. The aortic arch cine was used to plan perpendicular cines through the largest portion of the descending aorta for measurement.
Figure 1 AOrtic dissection.pdf
CMR sequences used on pregnant ACHD patients during the first CMR.
Figure 2. CMR sequences used..pdf
