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Cardiovascular magnetic resonance has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of cardiovascular magnetic resonance in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of cardiovascular magnetic resonance in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.

Objective— The dominant-negative mutation, P467L , in peroxisome proliferator–activated receptor-γ (PPARγ) affects adipose tissue distribution, insulin sensitivity, and blood pressure in heterozygous humans. We hypothesized that the equivalent mutation, PPARγ- P465L , in mice will worsen atherosclerosis. Methods and Results— Apolipoprotein E–null mice with and without PPARγ- P465L mutation were bred in 129S6 inbred genetic background. Mild hypertension and lipodystrophy of PPARγ- P465L persisted in the apolipoprotein E–null background. Glucose homeostasis was normal, but plasma adiponectin was significantly lower and resistin was higher in PPARγ- P465L mice. Plasma cholesterol and lipoprotein distribution were not different, but plasma triglycerides tended to be reduced. Surprisingly, there were no overall changes in the atherosclerotic plaque size or composition. PPARγ- P465L macrophages had a small decrease in CD36 mRNA and a small yet significant reduction in very-low-density lipoprotein uptake in culture. In unloaded apolipoprotein E–null macrophages with PPARγ- P465L , cholesterol uptake was reduced whereas apolipoprotein AI–mediated efflux was increased. However, when cells were cholesterol loaded in the presence of acetylated low-density lipoprotein, no genotype difference in uptake or efflux was apparent. A reduction of vascular cell adhesion molecule-1 expression in aorta suggests a relatively antiatherogenic vascular environment in mice with PPARγ- P465L . Conclusion— Small, competing pro- and antiatherogenic effects of PPARγ- P465L mutation result in unchanged plaque development in apolipoprotein E–deficient mice.