Novel cardiac magnetic resonance imaging sequences used in congenital heart disease

Recent advancements in cardiac magnetic resonance imaging have significantly enhanced the diagnostic accuracy and management of congenital heart disease. Modern magnetic resonance imaging sequences, such as steady-state free precession, phase-contrast imaging, and late gadolinium enhancement, offer detailed anatomical and functional insights, which are crucial for precise diagnosis, surgical planning, and long-term follow-up. These sequences allow for comprehensive assessment of complex cardiac structures, hemodynamics, and myocardial tissue characterization, thereby improving patient outcomes and aiding in the effective treatment of congenital heart disease. The integration of advanced imaging techniques like phase-contrast magnetic resonance imaging, 3D printing, and computational fluid dynamics has revolutionized the evaluation and management of congenital heart disease. Phase contrast magnetic resonance imaging provides comprehensive hemodynamic data, enabling precise assessment of blood flow patterns and quantification of flow parameters. These detailed flow analyses are further enhanced by 3D printing, which creates patient-specific models for pre-surgical planning and education. Together, these technologies offer a multifaceted approach to congenital heart disease, improving diagnostic accuracy, surgical planning, and patient-specific care. The first part of this thesis investigates differences in functional and 3D morphological characteristics of the right ventricular outflow tract and branch pulmonary arteries in patients with surgically corrected tetralogy of Fallot, which is referred to as surgical or transcatheter pulmonary valve replacements. The study found the reduced circumferential and radial strain in the right ventricle in the surgical valve replacement group by using cardiac magnetic resonance imaging with multiplanar reconstructions, 3D volume rendering, and 3D printed models for pre-procedural assessment. A significant correlation was noted between right ventricular outflow tract types and strain parameters. This study addresses a critical gap in understanding the effects of transcatheter pulmonary valve replacement on myocardial strain in patients with surgically corrected tetralogy of Fallot. The second part of this thesis is dedicated to determining the effects of transcatheter pulmonary valve replacement on atrial and ventricular strain in patients with surgically corrected tetralogy of Fallot using feature-tracking strain evaluation of cardiac magnetic resonance imaging. By demonstrating that pulmonary valve replacement leads to significant changes not only in volume and function parameters but also in strain characteristics it provides a deeper understanding of myocardial function in these patients. The study suggests incorporating strain analysis into routine cardiac magnetic resonance imaging protocols for a more comprehensive assessment.