Safety of cardiac magnetic resonance and contrast angiography for neonates and small infants

A 10-year single-institution experience

Sheela Rangamani, Joby Varghese, Ling Li, Lisa Harvey, James M Hammel, Scott E. Fletcher, Kim F Duncan, David Alan Danford, Shelby Kutty

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

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 (SpO2) 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°F), desaturation (SpO2 drop ≥10% below baseline) and bradycardia (heart rate ≤100 bpm). Secondary outcome measure was unplanned overnight hospitalization of outpatients. Results Children (n0143; 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 0.22m2 (0.13-0.32m2). There were 118 (83%) inpatients (108 receiving intensive care) and 25 (17%) outpatients. Indications for CMR were assessment of aortic arch (n057), complex CHD (n041), pulmonary veins (n015), vascular ring (n08), intracardiac mass (n08), pulmonary artery (n0 7), ventricular volume (n04), and systemic veins (n03). 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 (n02), hypothermia (n05), bradycardia (n02), and bradycardia with hypoxemia (n02). 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 presurgical cardiac indications. Adverse events were unrelated to patient age, complexity of heart disease, type of anesthesia or PGE1 dependence.

Original languageEnglish (US)
Pages (from-to)1339-1346
Number of pages8
JournalPediatric Radiology
Volume42
Issue number11
DOIs
StatePublished - Nov 1 2012

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Magnetic Resonance Angiography
antineoplaston A10
Alprostadil
Magnetic Resonance Spectroscopy
Deep Sedation
Newborn Infant
Safety
Outpatients
Bradycardia
General Anesthesia
Heart Diseases
Anesthesia
Hypothermia
Inpatients
Incidence
Nursing Records
Outcome Assessment (Health Care)
Temperature
Pulmonary Veins
Body Surface Area

Keywords

  • Cardiac MRI
  • Infants
  • Magnetic resonance angiography
  • Neonates
  • Safety

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Pediatrics, Perinatology, and Child Health

Cite this

Safety of cardiac magnetic resonance and contrast angiography for neonates and small infants : A 10-year single-institution experience. / Rangamani, Sheela; Varghese, Joby; Li, Ling; Harvey, Lisa; Hammel, James M; Fletcher, Scott E.; Duncan, Kim F; Danford, David Alan; Kutty, Shelby.

In: Pediatric Radiology, Vol. 42, No. 11, 01.11.2012, p. 1339-1346.

Research output: Contribution to journalArticle

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title = "Safety of cardiac magnetic resonance and contrast angiography for neonates and small infants: A 10-year single-institution experience",
abstract = "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 (SpO2) 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°F), desaturation (SpO2 drop ≥10{\%} below baseline) and bradycardia (heart rate ≤100 bpm). Secondary outcome measure was unplanned overnight hospitalization of outpatients. Results Children (n0143; 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 0.22m2 (0.13-0.32m2). There were 118 (83{\%}) inpatients (108 receiving intensive care) and 25 (17{\%}) outpatients. Indications for CMR were assessment of aortic arch (n057), complex CHD (n041), pulmonary veins (n015), vascular ring (n08), intracardiac mass (n08), pulmonary artery (n0 7), ventricular volume (n04), and systemic veins (n03). 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 (n02), hypothermia (n05), bradycardia (n02), and bradycardia with hypoxemia (n02). 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 presurgical cardiac indications. Adverse events were unrelated to patient age, complexity of heart disease, type of anesthesia or PGE1 dependence.",
keywords = "Cardiac MRI, Infants, Magnetic resonance angiography, Neonates, Safety",
author = "Sheela Rangamani and Joby Varghese and Ling Li and Lisa Harvey and Hammel, {James M} and Fletcher, {Scott E.} and Duncan, {Kim F} and Danford, {David Alan} and Shelby Kutty",
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TY - JOUR

T1 - Safety of cardiac magnetic resonance and contrast angiography for neonates and small infants

T2 - A 10-year single-institution experience

AU - Rangamani, Sheela

AU - Varghese, Joby

AU - Li, Ling

AU - Harvey, Lisa

AU - Hammel, James M

AU - Fletcher, Scott E.

AU - Duncan, Kim F

AU - Danford, David Alan

AU - Kutty, Shelby

PY - 2012/11/1

Y1 - 2012/11/1

N2 - 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 (SpO2) 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°F), desaturation (SpO2 drop ≥10% below baseline) and bradycardia (heart rate ≤100 bpm). Secondary outcome measure was unplanned overnight hospitalization of outpatients. Results Children (n0143; 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 0.22m2 (0.13-0.32m2). There were 118 (83%) inpatients (108 receiving intensive care) and 25 (17%) outpatients. Indications for CMR were assessment of aortic arch (n057), complex CHD (n041), pulmonary veins (n015), vascular ring (n08), intracardiac mass (n08), pulmonary artery (n0 7), ventricular volume (n04), and systemic veins (n03). 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 (n02), hypothermia (n05), bradycardia (n02), and bradycardia with hypoxemia (n02). 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 presurgical cardiac indications. Adverse events were unrelated to patient age, complexity of heart disease, type of anesthesia or PGE1 dependence.

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 (SpO2) 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°F), desaturation (SpO2 drop ≥10% below baseline) and bradycardia (heart rate ≤100 bpm). Secondary outcome measure was unplanned overnight hospitalization of outpatients. Results Children (n0143; 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 0.22m2 (0.13-0.32m2). There were 118 (83%) inpatients (108 receiving intensive care) and 25 (17%) outpatients. Indications for CMR were assessment of aortic arch (n057), complex CHD (n041), pulmonary veins (n015), vascular ring (n08), intracardiac mass (n08), pulmonary artery (n0 7), ventricular volume (n04), and systemic veins (n03). 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 (n02), hypothermia (n05), bradycardia (n02), and bradycardia with hypoxemia (n02). 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 presurgical cardiac indications. Adverse events were unrelated to patient age, complexity of heart disease, type of anesthesia or PGE1 dependence.

KW - Cardiac MRI

KW - Infants

KW - Magnetic resonance angiography

KW - Neonates

KW - Safety

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SP - 1339

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JO - Pediatric Radiology

JF - Pediatric Radiology

SN - 0301-0449

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