Assessment of Double Chamber Right Ventricle by Magnetic Resonance Imaging
A 33-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.
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.
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.
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