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Missed Connections: Identification of Atrial Septal Defect by MRI. Case Rep Cardiol 2023; 2023:2393308. [PMID: 36890877 PMCID: PMC9988386 DOI: 10.1155/2023/2393308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/30/2022] [Accepted: 02/06/2023] [Indexed: 03/03/2023] Open
Abstract
In this case report, we describe a 55-year-old female patient with worsening exertional dyspnea who is referred to the cardiology department, due to the appearance of worsening pulmonary vascular disease on computed tomography (CT) of the chest. Previous transthoracic echocardiograms (TTE) identified right ventricle enlargement, but no other structural abnormalities. She completed cardiac magnetic resonance (CMR) imaging, which identified a large secundum atrial septal defect (ASD). She subsequently underwent surgical planning and correction of the lesion with improvement of her symptoms. This case and a growing body of literature support the use of CMR as an alternative imaging modality for the diagnosis of congenital heart disease (CHD).
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Abid D, Daoud E, Ben Kahla S, Mallek S, Abid L, Fourati H, Mnif Z, Kammoun S. Unrepaired persistent truncus arteriosus in a 38-year-old woman with an uneventful pregnancy. Cardiovasc J Afr 2015; 26:e6-8. [PMID: 26407331 PMCID: PMC4683288 DOI: 10.5830/cvja-2015-005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 01/11/2015] [Indexed: 11/25/2022] Open
Abstract
Persistent truncus arteriosus (PTA) is a rare conotruncal defect, defined as a single arterial vessel arising from the heart, which gives origin to the systemic, pulmonary and coronary circulations. It has an extremely poor prognosis and carries a high mortality rate during the early years of life unless surgically repaired. A few known cases have been reported of patients reaching maturity, and exceptionally, patients suffering from this disease having lived into the fourth decade. The purpose of this report was to present a new case of PTA type 1, diagnosed by echocardiography and MRI, in a 41-year-old woman, with the peculiarity of long survival into adult life. She had also experienced a full-term pregnancy and delivery of a normal infant three years prior to her diagnosis. Pulmonary vascular disease made her condition inoperable but she was doing well with medical management after a follow up of 15 months. Based on this work, we concluded that pulmonary arterial hypertension is deleterious for life in some cardiovascular diseases, but in others, allows survival, as occurred in these patients with PTA. The patient’s clinical course and anatomical findings are reported, along with factors that may have contributed to her longevity.
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Affiliation(s)
- Dorra Abid
- Cardiology Department, Hedi Chaker Hospital, Sfax, Tunisia.
| | - Emna Daoud
- Department of Radiology, Hedi Chaker Hospital, Sfax, Tunisia
| | | | - Souad Mallek
- Cardiology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Leila Abid
- Cardiology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Hela Fourati
- Department of Radiology, Hedi Chaker Hospital, Sfax, Tunisia
| | - Zeineb Mnif
- Department of Radiology, Hedi Chaker Hospital, Sfax, Tunisia
| | - Samir Kammoun
- Cardiology Department, Hedi Chaker Hospital, Sfax, Tunisia
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Daruwalla VJ, Parekh K, Tahir H, Collins JD, Carr J. Raghib Syndrome Presenting as a Cryptogenic Stroke: Role of Cardiac MRI in Accurate Diagnosis. Case Rep Cardiol 2015; 2015:921247. [PMID: 26106490 PMCID: PMC4461698 DOI: 10.1155/2015/921247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/15/2015] [Accepted: 05/19/2015] [Indexed: 11/24/2022] Open
Abstract
Raghib Syndrome is a rare developmental complex, which consists of persistence of the left superior vena cava (PLSVC) along with coronary sinus ostial atresia and atrial septal defect. This Raghib complex anomaly has also been associated with other congenital malformations including ventricular septal defects, enlargement of the tricuspid annulus, and pulmonary stenosis. Our case demonstrates an isolated PLSVC draining into the left atrium along with coronary sinus atresia in a young patient presenting with cryptogenic stroke without the atrial septal defect. Majority of the cases reported in the literature were found to have the lesion during the postmortem evaluation or were characterized at angiography and/or echocardiography. We stress the importance of modern day imaging like the computed tomography (CT) angiography and cardiac MRI in diagnosis and surgical management of such rare lesions leading to cryptogenic strokes.
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Affiliation(s)
| | - Keyur Parekh
- Department of Cardiovascular Radiology, Northwestern University Feinberg School of Medicine, USA
| | - Hassan Tahir
- Conemaugh Memorial Hospital/Temple University, USA
| | - Jeremy D. Collins
- Department of Cardiovascular Radiology, Northwestern University Feinberg School of Medicine, USA
| | - James Carr
- Department of Cardiovascular Radiology, Northwestern University Feinberg School of Medicine, USA
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Murthy A, Jain A, El-Hajjar M. Unroofed Coronary Sinus Presenting as Cerebral Abscess: A Case Report. Cardiol Res 2013; 4:116-120. [PMID: 28352431 PMCID: PMC5358249 DOI: 10.4021/cr273w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2013] [Indexed: 11/15/2022] Open
Abstract
A sixty eight year-old woman with a long-standing history of hypertension, dizziness and a history of congenital heart disease presented with speech difficulties and disorientation. She was diagnosed with a brain abscess, confirmed by a stereotactic biopsy. Transthoracic echocardiographic evaluation revealed a persistent left superior vena cava (PLSVC) with an unroofed coronary sinus (URCS) along with a small secundum atrial septal defect. Her heart catheterization showed a partially unroofed coronary sinus along with a bidirectional shunt. She was referred for surgical closure of her unroofed coronary sinus and the secundum atrial septal defect. Her brain abscess responded well to antibiotic treatment. While waiting for open-heart surgery, she suffered from an acute myocardial infarction and underwent emergent percutaneous coronary intervention to the right coronary artery. Subsequently, she underwent elective surgical repair of the unroofed coronary sinus, along with closure of the atrial septal defect. When she was seen in follow-up she reported a complete resolution of her dizziness and felt more energetic. Unroofed coronary sinus syndrome (URCS) is a rare congenital cardiac anomaly in which there is a communication between the coronary sinus and the left atrium. While non-invasive imaging with echocardiography, MRI or CT is helpful in making the diagnosis, cardiac catheterization remains integral in the evaluation and management planning. Management is guided by the presence of clinical symptoms with consideration of repair when patients become symptomatic. Prognosis after surgery is excellent, recently transcatheter based treatment therapies are becoming more frequent. We present a rare case of URCS with PLSVC presenting as a cerebral abscess in late adulthood. She had bidirectional shunting manifesting as a cerebral abscess. She responded well to the corrective surgery and was doing well on follow up.
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Affiliation(s)
- Avinash Murthy
- Division of Cardiology, Albany Medical Center, MC-44, 47 New Scotland Avenue, Albany, NY, 12208, USA
| | - Ankit Jain
- Division of Cardiology, Albany Medical Center, MC-44, 47 New Scotland Avenue, Albany, NY, 12208, USA
| | - Mohammad El-Hajjar
- Division of Cardiology, Albany Medical Center, MC-44, 47 New Scotland Avenue, Albany, NY, 12208, USA
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5
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Quantitative analysis of pulmonary artery and pulmonary collaterals in preoperative patients with pulmonary artery atresia using dual-source computed tomography. Eur J Radiol 2011; 79:480-5. [PMID: 20627639 DOI: 10.1016/j.ejrad.2010.04.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 04/24/2010] [Accepted: 04/28/2010] [Indexed: 11/21/2022]
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6
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Geva T. Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support. J Cardiovasc Magn Reson 2011; 13:9. [PMID: 21251297 PMCID: PMC3036629 DOI: 10.1186/1532-429x-13-9] [Citation(s) in RCA: 369] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 01/20/2011] [Indexed: 11/10/2022] Open
Abstract
Surgical management of tetralogy of Fallot (TOF) results in anatomic and functional abnormalities in the majority of patients. Although right ventricular volume load due to severe pulmonary regurgitation can be tolerated for many years, there is now evidence that the compensatory mechanisms of the right ventricular myocardium ultimately fail and that if the volume load is not eliminated or reduced by pulmonary valve replacement the dysfunction might be irreversible. Cardiovascular magnetic resonance (CMR) has evolved during the last 2 decades as the reference standard imaging modality to assess the anatomic and functional sequelae in patients with repaired TOF. This article reviews the pathophysiology of chronic right ventricular volume load after TOF repair and the risks and benefits of pulmonary valve replacement. The CMR techniques used to comprehensively evaluate the patient with repaired TOF are reviewed and the role of CMR in supporting clinical decisions regarding pulmonary valve replacement is discussed.
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Affiliation(s)
- Tal Geva
- Department of Cardiology, Children's Hospital Boston, Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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9
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Gutiérrez FR, Ho ML, Siegel MJ. Practical Applications of Magnetic Resonance in Congenital Heart Disease. Magn Reson Imaging Clin N Am 2008; 16:403-35, v. [DOI: 10.1016/j.mric.2008.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Geva T. Indications and timing of pulmonary valve replacement after tetralogy of Fallot repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2006:11-22. [PMID: 16638542 DOI: 10.1053/j.pcsu.2006.02.009] [Citation(s) in RCA: 173] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Surgical management of tetralogy of Fallot results in anatomic and functional abnormalities in the majority of patients. Although right ventricular volume load due to severe pulmonary regurgitation can be tolerated for years, there is now evidence that the compensatory mechanisms of the right ventricular myocardium ultimately fail and that if the volume load is not eliminated or reduced the dysfunction might be irreversible. In light of that data and with better understanding of risk factors for adverse outcomes late after tetralogy of Fallot repair, many centers are now recommending early pulmonary valve replacement before symptoms of heart failure develop. This article reviews the pathophysiology of chronic right ventricular volume load after tetralogy of Fallot repair and the risks and benefits of pulmonary valve replacement. Finally, recommendations for timing and indications for pulmonary valve replacement are given.
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Affiliation(s)
- Tal Geva
- Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA.
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Boechat MI, Ratib O, Williams PL, Gomes AS, Child JS, Allada V. Cardiac MR Imaging and MR Angiography for Assessment of Complex Tetralogy of Fallot and Pulmonary Atresia. Radiographics 2005; 25:1535-46. [PMID: 16284133 DOI: 10.1148/rg.256045052] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Breath-hold electrocardiographically gated cardiac magnetic resonance (MR) imaging and contrast material-enhanced MR angiography are emerging as ideal techniques for the evaluation of complex congenital heart disease. Tetralogy of Fallot is the most common cause of cyanotic congenital heart disease and, in its classic form, is associated with varying degrees of hypoplasia of the central and peripheral pulmonary arteries, with valvar pulmonary atresia and collateral aortopulmonary vessels occupying the extreme end of the spectrum. Accurate assessment of the size and anatomy of the pulmonary arteries is often difficult with echocardiography and conventional cineangiography. Compared with echocardiography in particular, cardiac MR imaging with three-dimensional reconstruction has distinct advantages for pre- or postoperative assessment of pulmonary anatomy in patients with tetralogy of Fallot and pulmonary atresia. MR imaging enables the clear and complete depiction of anatomy and thus can provide additional information about pulmonary artery abnormalities that are difficult to evaluate with conventional cardiac imaging techniques.
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Affiliation(s)
- M Ines Boechat
- Department of Radiological Sciences, University of California, David Geffen School of Medicine, Box 951721, Los Angeles, CA 90095-1721, USA.
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Sato Y, Inoue F, Matsumoto N, Tani S, Takayama T, Yoda S, Kunimasa T, Ishii N, Uchiyama T, Saito S, Tanaka H, Furuhashi S, Takahashi M, Koyama Y. Detection of Anomalous Origins of the Coronary Artery by Means of Multislice Computed Tomography. Circ J 2005; 69:320-4. [PMID: 15731538 DOI: 10.1253/circj.69.320] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Anomalous origins of the coronary artery are rare, but may cause myocardial ischemia and sudden death. Thus, their reliable identification is crucial for any imaging method that attempts coronary artery visualization and of those available multislice computed tomography (MSCT), which provides excellent spatial resolution, may be the most promising. METHODS AND RESULTS In consecutive 1,153 patients, MSCT identified 5 patients (0.43 %) with an anomalous origin of the coronary artery. The left circumflex artery (LCX) originated from the right sinus of Valsalva in 1 patient, and the right coronary artery originated from the left sinus of Valsalva and coursed between the aortic root and the pulmonary artery in 3 patients. In 1 patient, MSCT identified the absence of the LCX and high-grade atherosclerotic stenosis in the right coronary artery. CONCLUSION MSCT can detect the anomalous origin and course of the coronary artery in relation to the great vessels. It is also useful for identifying atherosclerotic coronary artery disease superimposed on the anomalous vascular system.
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Affiliation(s)
- Yuichi Sato
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan.
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Fyfe DA, Parks WJ. Noninvasive diagnostics in congenital heart disease: echocardiography and magnetic resonance imaging. Crit Care Nurs Q 2002; 25:26-36. [PMID: 12450157 DOI: 10.1097/00002727-200211000-00005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The ability to noninvasively diagnose even the most complex congenital heart disease is one of the greatest advances in the care of children with cardiac defects. Initially, two-dimensional echocardiography displayed anatomy; later, Doppler allowed the quantitation of pressure and flow. Using these modalities, cardiac catheterization is unnecessary for most children with cardiac defects. Echocardiography also is routinely used for intraoperative and fetal cardiac imaging. Three-dimensional magnetic resonance imaging can now quantitate volumes of irregular shaped heart chambers (eg, the right ventricle) and blood flow (eg, as from a leaking valve). As technology moves further into the digital age, developments will continue to facilitate noninvasive diagnosis and treatment of children with congenital heart disease.
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Affiliation(s)
- Derek Alan Fyfe
- Sibley Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
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