PMID- 22885603
OWN - NLM
STAT- MEDLINE
DCOM- 20130411
LR  - 20211021
IS  - 1432-1998 (Electronic)
IS  - 0301-0449 (Linking)
VI  - 42
IP  - 11
DP  - 2012 Nov
TI  - Safety of cardiac magnetic resonance and contrast angiography for neonates and 
      small infants: a 10-year single-institution experience.
PG  - 1339-46
LID - 10.1007/s00247-012-2452-9 [doi]
AB  - BACKGROUND: With increasing applications of cardiac magnetic resonance (CMR) and 
      magnetic resonance angiography (MRA) for evaluation of congenital heart disease 
      (CHD), safety of this technology in the very young is of particular interest. 
      OBJECTIVE: We report our 10-year experience with CMR in neonates and small 
      infants with particular focus on the safety profile and incidence of adverse 
      events (AEs). MATERIALS AND METHODS: We reviewed clinical, anesthesia and nursing 
      records of all children </=120 days of age who underwent CMR. We recorded variables 
      including cardiac diagnosis, study duration, anesthesia type and agents, 
      prostaglandin E1 (PGE1) dependence and gadolinium (Gd) use. Serially recorded 
      temperature, systemic saturation (SpO(2)) and cardiac rhythm were analyzed. 
      Primary outcome measure was any AE during or <24 h after the procedure, including 
      minor AEs such as hypothermia (axillary temperature </=95  degrees F), desaturation (SpO(2) 
      drop >/=10% below baseline) and bradycardia (heart rate </=100 bpm). Secondary 
      outcome measure was unplanned overnight hospitalization of outpatients. RESULTS: 
      Children (n = 143; 74 boys, 69 girls) had a median age of 6 days (1-117), and 98 
      were </=30 days at the time of CMR. The median weight was 3.4 kg (1.4-6 kg) and 
      body surface area 0.22 m(2) (0.13-0.32 m(2)). There were 118 (83%) inpatients 
      (108 receiving intensive care) and 25 (17%) outpatients. Indications for CMR were 
      assessment of aortic arch (n = 57), complex CHD (n = 41), pulmonary veins (n = 
      15), vascular ring (n = 8), intracardiac mass (n = 8), pulmonary artery (n = 7), 
      ventricular volume (n = 4), and systemic veins (n = 3). CMR was performed using a 
      1.5-T scanner and a commercially available coil. CMR utilized general anesthesia 
      (GA) in 86 children, deep sedation (DS) in 50 and comforting methods in seven. 
      MRA was performed in 136 children. Fifty-nine children were PGE1-dependent and 39 
      had single-ventricle circulation. Among children on PGE1, 43 (73%) had GA and 10 
      (17%) had DS. Twelve children (9%) had adverse events (AEs)-one major and 11 
      minor. Of those 12, nine children had GA (10%) and three had DS (6%). The single 
      major AE was respiratory arrest after DS in a neonate (resuscitated without 
      sequelae). Minor AEs included desaturations (n = 2), hypothermia (n = 5), 
      bradycardia (n = 2), and bradycardia with hypoxemia (n = 2). Incidence of minor 
      AEs was 9% for inpatients (vs. 4% for outpatients), and 8% for neonates (vs. 9% 
      for age >/=30 days). Incidence of minor AEs was similar between PGE1-dependent 
      infants and the non-PGE1 group. There were no adverse events related to MRA. Of 
      25 outpatients, 5 (20%) were admitted for overnight observation due to 
      desaturations. CONCLUSION: CMR and MRA can be accomplished safely in neonates and 
      infants </=120 days old for a wide range of pre-surgical cardiac indications. 
      Adverse events were unrelated to patient age, complexity of heart disease, type 
      of anesthesia or PGE1 dependence.
FAU - Rangamani, Sheela
AU  - Rangamani S
AD  - Joint Division of Pediatric Cardiology, University of Nebraska College of 
      Medicine/Creighton University School of Medicine, 8200 Dodge St., Omaha, NE 
      68114, USA.
FAU - Varghese, Joby
AU  - Varghese J
FAU - Li, Ling
AU  - Li L
FAU - Harvey, Lisa
AU  - Harvey L
FAU - Hammel, James M
AU  - Hammel JM
FAU - Fletcher, Scott E
AU  - Fletcher SE
FAU - Duncan, Kim F
AU  - Duncan KF
FAU - Danford, David A
AU  - Danford DA
FAU - Kutty, Shelby
AU  - Kutty S
LA  - eng
PT  - Journal Article
DEP - 20120812
PL  - Germany
TA  - Pediatr Radiol
JT  - Pediatric radiology
JID - 0365332
RN  - 0 (Anesthetics, General)
RN  - 0 (Contrast Media)
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
MH  - Anesthetics, General/*therapeutic use
MH  - Bradycardia/*epidemiology
MH  - Comorbidity
MH  - Contrast Media
MH  - Drug-Related Side Effects and Adverse Reactions/*epidemiology
MH  - Female
MH  - *Gadolinium
MH  - Humans
MH  - Hypothermia/*epidemiology
MH  - Incidence
MH  - Infant
MH  - Infant, Newborn
MH  - Longitudinal Studies
MH  - Magnetic Resonance Angiography/*statistics & numerical data
MH  - Magnetic Resonance Imaging, Cine/*statistics & numerical data
MH  - Male
MH  - Nebraska/epidemiology
MH  - Retrospective Studies
MH  - Risk Assessment
EDAT- 2012/08/14 06:00
MHDA- 2013/04/12 06:00
CRDT- 2012/08/14 06:00
PHST- 2012/03/09 00:00 [received]
PHST- 2012/05/22 00:00 [accepted]
PHST- 2012/05/22 00:00 [revised]
PHST- 2012/08/14 06:00 [entrez]
PHST- 2012/08/14 06:00 [pubmed]
PHST- 2013/04/12 06:00 [medline]
AID - 10.1007/s00247-012-2452-9 [doi]
PST - ppublish
SO  - Pediatr Radiol. 2012 Nov;42(11):1339-46. doi: 10.1007/s00247-012-2452-9. Epub 
      2012 Aug 12.