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(Circulation. 2002;105:2692.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

Assessment of Double Chamber Right Ventricle by Magnetic Resonance Imaging

Tareq Ibrahim, MD; Karl Dennig, MD; Markus Schwaiger, MD; Albert Schömig, MD

From Deutsches Herzzentrum München & I. Medizinische Klinik (T.I., K.D., A.S.), and Nuklearmedizinische Klinik (M.S.), Technische Universität München, Munich, Germany.

Correspondence to Tareq Ibrahim, MD, Deutsches Herzzentrum München & I. Medizinische Klinik, Technische, Universität München, Lazarettstr. 36, 80636 München, Germany. E-mail T.Ibrahim@ Lrz.tu-muenchen.de

A33-year-old woman, admitted for a tonsillectomy, was referred for preoperative cardiac evaluation because of a systolic murmur at the low left sternal border. She complained of exertional dyspnea for the previous 3 months. ECG showed right bundle branch block. Doppler-echocardiography, limited by poor imaging quality, demonstrated a small perimembranous ventricular septal defect and an additional turbulent flow originating from the middle portion of the right ventricle (RV). Further MRI evaluation was performed using 1.5 Tesla.

Turbo-spin-echo images demonstrated marked RV hypertrophy subdividing its cavum into a proximal and a distal chamber (Figure 1). Cine-mode turbo-gradient-echo images revealed a turbulent jet emerging from the mid-ventricular obstruction toward the RV outflow tract (Figure 2). Pulmonary stenosis was excluded, leading to the diagnosis of double-chamber right ventricle with hemodynamic relevant obstruction.

View larger version (146K): [in this window] [in a new window]   Figure 1. Turbo-spin-echo MR image in coronal orientation demonstrates a muscle band subdividing the right ventricle into a proximal (lower) and distal (upper) chamber. RA indicates right atrium; pRV, proximal right chamber; and dRV, distal right chamber.

View larger version (87K): [in this window] [in a new window]   Figure 2. Gradient-echo cine-MR images in coronal orientation at end-diastole (left) and end-systole (right) demonstrating a turbulent systolic jet emerging from the mid-ventricular obstruction (arrow).

Cardiac catheterization registered an RV systolic pressure gradient of 60 mm Hg and a ventricular septal defect (VSD) with a small LR-shunt. The patient underwent successful surgical resection of hypertrophy and closure of the VSD.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ibrahim, T. Articles by Schömig, A. Search for Related Content PubMed PubMed Citation Articles by Ibrahim, T. Articles by Schömig, A. Related Collections Hypertrophy CT and MRI Cardiac development