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(Circulation. 2000;102:e71.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Magnetic Resonance Angiography of a Pulmonary Artery Stenosis Late After Cardiac Surgery

Robert J. M. van Geuns, MD; Matthijs Oudkerk, MD, PhD; Pim J. de Feyter, MD, PhD; Silja E. Spitaels, MD, PhD

From the Department of Cardiology, Thoraxcenter (R.J.M.v.G., P.J.d.F., S.E.S.) and the Department of Radiology, Dr Daniel den Hoedkliniek, University Hospital Rotterdam (M.O.), Rotterdam, The Netherlands.

Correspondence to Robert J.M. van Geuns, MD, Department of Cardiology, Thoraxcenter, Bd 406, University Hospital Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail vangeuns@card.azr.nl

A19-year-old man with known dextrocardia, situs inversus, and complete surgical correction of a double-outlet right ventricle was seen in the outpatient clinic for follow-up after total correction, including the implantation of a pulmonary homograft. During echocardiography, a dilated right atrium and right ventricle were noted. Increased right ventricular pressure (50 mm Hg; tricuspid regurgitation, 3.5 m/s) could only partially be explained by pulmonary valve stenosis. The pulmonary artery branches could not be visualized echocardiographically. Magnetic resonance angiography was performed using the breath-hold contrast-enhanced 3D gradient echo sequence described by Prince et al.¹ The imaging time was 24 seconds and the resolution was 1.0x2.6x1.3 mm. After the acquisition, the datasets were transferred to a dedicated graphic workstation (Indigo2, Silicon Graphics) for 3D evaluation with a volume-rendering technique^{2 3} using commercially available software (VoxelView, Vital Images). Three-dimensional representation with volume rendering showed the situs inversus very clearly (Figure 1). The pulmonary homograft is located on the right side of the patient, with the ascending aorta on the left and descending aorta to the right of the spine. The branch vessels are reversed, with a left brachiocephalic artery as the first arch branch.

View larger version (115K): [in this window] [in a new window]   Figure 1. Breath-hold contrast-enhanced magnetic resonance angiography of a patient with situs inversus. Ao indicates aorta; PA, pulmonary artery; RV, right ventricle; RA, right atrium; R, right side of patient; and L, left side of patient. Arrow indicates left brachiocephalic artery.

To visualize the pulmonary artery branches, the heart and aorta were subtracted from the source images (Figure . . . [Full Text of this Article]