Case from: Sivan Lieberman, Anil K Attili, Adam L Dorfman:University of Michigan
History: A 52 year old male with a dilated right ventricle and elevated pulmonary artery pressures on echocardiography.
CMR Findings: Dilated right ventricle (EDV 179ml/sqm) and right atrium. Dilated main pulmonary artery. No ASD detected, but anomalous pulmonary venous connections of the entire right lung to the SVC and right atrium. No Scimitar syndrome, no sinus venosus ASD. Normal pulmonary venous connections of the left lung to the left atrium. Qp/Qs 2.4:1
CMR Points: In RV dilatation, CMR is of great utility. It can:
Assess function and RV cardiomyopathy
Assess Qp:Qs, in this case showing volume overload.
Identify intracardiac shunts
Identify extracardiac shunts, in this case PAPVD
CMR can be considered a non-invasive alternative to cardiac catheterization in this group of patients.
** If, as a CMR practionner, a patient is referred for CMR as "?ARVC", and there is RVdilatation, consider the possibility of a shunt and systematically exclude or search for it.
Outcome: The patient underwent an uneventful surgical repair accomplished by creating an ASD and then constructing an intra-atrial baffle from the anomalous pulmonary veins through the ASD to the left atrium.
References: Ferrari VA, Scott CH, Holland GA, Axel L, St. John Sutton M: Ultrafast three-dimensional contrast-enhanced MRA and imaging in the diagnosis of partial anomalous pulmonary venous drainage. JACC 2001;37:1120-8.. (full text)
Prasad SK, Soukias N, Hornung T, Khan M, Pennell DJ, Gatzoulis MA, Mohiaddin RM. Role of MRA in the Diagnosis of Major Aortopulmonary Collateral Arteries and Partial Anomalous Pulmonary Venous Drainage.Circulation. 2004;109:207-214 (full text)