Pediatric and Congenital Heart Disease Session 6: Pediatric and Congenital Cases
2 - Magnetic Resonance Imaging in Pediatric Patient with Dextrocardia and a Large Left Ventricular Outflow Tract Aneurysm
Saturday, February 15, 2020
8:15 AM – 8:22 AM
Location: Salon J2
Description of Clinical Presentation: Here we present a pediatric patient with complex congenital heart disease consisting of dextrocardia, large perimembranous ventricular septal defect status post repair, and subaortic tunnel status post resection. In routine follow up, surveillance echocardiography showed increased aortic valve insufficiency and an outpouching in the lateral-posterior portion of the left ventricular outflow tract suspicious for an LVOT aneurysm into the left atrium. Cardiac magnetic resonance imaging using a ferumoxytol-enhanced 3D whole heart imaging demonstrated a large aneurysm along the lateral border of the left ventricular outflow tract as well as prolapse of the left aortic cusp causing moderate aortic insufficiency. Furthermore, the left anterior descending coronary artery was seen coursing just lateral to the pulsating left ventricular outflow tract aneurysm. Superior-inferior relationship of the right and left ventricle, morphology of the both atrial appendages, and anatomy of hepatic and portal vessels were also clearly delineated. This patient’s left ventricular outflow tract aneurysm has been monitored serially using this technique without changes to size or characteristics.
Diagnostic Techniques and Their Most Important Findings: Ferumoxytol-enhanced cardiac magnetic resonance imaging using respiratory gated inversion sequence recovery FGRE 3D whole heart pulse sequence with a 3T platform was used. This imaging acquisition technique allows for comprehensive evaluation of cardiac and vascular structures at high temporal and spatial resolution with excellent signal and contrast.
Learning Points from this
Case: This case demonstrates the value of ferumoxytol-enhanced cardiac magnetic resonance imaging in characterizing complex congenital heart disease noninvasively without the use of ionizing radiation. This imaging technique allows for high resolution assessment of even small structures including coronary ostia and valve leaflets. It is also valuable in the comprehensive analysis of ventricular function and flow.