[Minimally invasive pulmonary valve replacement in pediatric patients: importance of imaging].

CLINICAL/METHODICAL ISSUE: Right ventricular outflow tract (RVOT) dysfunction with pulmonary regurgitation or obstruction is a common postsurgical consequence in congenital heart disease.

STANDARD RADIOLOGICAL

METHODS

Magnetic resonance imaging (MRI) is widely accepted as standard method of imaging in congenital heart disease. It provides anatomical and functional information without radiation exposure and is therefore well suited for serial examinations.

METHODICAL INNOVATIONS: Percutaneous pulmonary valve implantation (PPVI) has been shown to be a safe and effective treatment option for patients with pulmonary valve insufficiency or stenosis. Correct patient selection for PPVI is crucial. It is important to be familiar with the indications and anatomical requirements for stent placement and to tailor imaging protocols.

PERFORMANCE: Imaging the RVOT, assessment of right ventricular volumes and function and calculation of pulmonary flow and regurgitation are core elements of the MRI examination prior to PPVI. Low interobserver and intraobserver variation allows even small changes to be detected.

ACHIEVEMENTS: Imaging provides relevant information for correct patient selection for PPVI and is part of postinterventional follow-up. Imaging is an important tool for documentation of success and for detection of complications.

PRACTICAL RECOMMENDATIONS: Several imaging modalities are used for evaluation of RVOTs; however, MRI can provide answers to most questions without radiation exposure.