Number 09-05 Locating the Leaks
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Number 09-05   Locating the Leaks

Case from: G. Cooper, S. Chatfield, R. Shifrin, and F. Al-Mousily Institution: Departments of Medicine, Pediatrics and Radiology, University of Florida  

Clinical history:  A 61 year old female with increasing dyspnea and a TTE raising the suspicion of endocardial cushion defect, was referred for CMR to define her anatomy and to measure shunt flow. Physical examination showed an RV lift, 2/6 systolic murmur, no diastolic murmurs or gallops. The second heart sound was widely split and moved normally with respiration.



Movie 1                                                                                      Movie 2



Movie 3                                                                                      Movie 4


CMR Findings: Complete A-V canal with primum ASD, membranous VSD, tricuspid regurgitation, mitral regurgitation, and common A-V valve which contributes to the septal leaflet of the tricuspid valve and the anterior leaflet of the mitral valve. Qp:Qs=1.9 to 1.

Perspective:  The anatomic defects are defined by the cine SSFP (Movie 1), high temporal resolution cine SSFP (Movie 2), and FLASH cine (Movie 3). Evaluating the valvular regurgitation and septal shunt flow is best seen on the high temporal resolution cine SSFP. The septal defect shunt flow can be seen on the velocity encoded cine (Movie 4). All of these 4 chamber views are in the same slice position. We prefer the use of high temporal resolution cine SSFP and velocity encoded cine to visualize turbulent flow in CMR.

Reference: Z. J. Wang, G.P. Reddy et al. Cardiovascular Shunts: MR Imaging Evaluation.. Radiographics. 2003;23:S181-S194 




COTW handling editor: Chiara Bucciarelli-Ducci

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