|Number 09-08 Syncopal Event in a Case of Kawasaki's|
Number 09-08 Syncopal Event in a Case of Kawasaki's
Anna Herrey, Vivienne Ezzat, Rory O'Hanlon, Marina Hughes, Malcolm Walker, James Moon.
Clinical history: A 22 year old woman with a history of Kawasaki's disease diagnosed aged 8 presented with a syncopal event. Echocardiography demonstrated an inter-atrial septum aneurysm. CMR was requested to define the coronary anatomy and evaluate the inter-atrial septal aneurysm.
The atrial SSFP images allow closer scrutiny of this region. Flow mapping did not demonstrate any L-R shunt (Qp:Qs 1.0)- Aortic and Pulmonary SV 83ml and 79ml by flow mapping respectively, and 85ml and 78ml by standard volumetric analysis. While a small PFO cannot be definitely ruled out, there is certainly no significant ASD associated with the atrial septal aneurysm. An inplane and through-plane flow map across the atrial septum did not demonstate a L-R flow/shunt (not shown).
Aortic Flow Mapping Pulmonary Flow Mapping
Finally, a non-breathold navigator 3D coronary acquisition was performed. Coronary images are best acquired by optimally timing diastasis (white arrows) using a high temporal resolution SSFP 4 chamber cine.
Timing for diastasis
The coronary images demonstrates non-dilated coronary arteries with normal origin and proximal course. Reformatting with Osirix demonstrate and separate the great cardiac vein from the coronaries showing no evidence of coronary involvement by Kawasaki's.
Non Breathhold Navigator 3D Whole Heart Sequence Osirix reformatting
Perspective: This case nicely highlights how CMR can be used to address several clinical questions in a single scan setting, avoiding the need for TEE+/- bubble study (?PFO ?ASD), CT Coronaries (aneurysmal dilatation due to Kawasaki's), and potentially R+L heart catheterisation (Qp:Qs).
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