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Number 07-08: Acquired VSD by CMR

Case from: Raju Ailiani, Umang Patel, Kevin Jaeger, Tim Tisue. Gundersen Lutheran Heart Institute, La Crosse, WI 54601

Clinical history: An 80 year old man with STEMI and cardiogenic shock.

Investigation: Triple vessel disease at angiography. Echo revealed Infero posterior hypokinesis.

Treatment: CABG. Post-operative echocardiography showed an infero-septal VSD. However, his clinical stability permitted initial conservative management, but a successive echo suggested possible RV dilatation and moderate pulmonary hypertension.

CMR: SSFP cine imaging did not well show the VSD, but spoiled gradient echo (FLASH) revealed 2 jets at the infarct site. The LV ejection fraction was 35%. Significant shunting (Qp:Qs =1.9) with moderate RA/RV dilatation.

Outcome: Referral for consideration of surgical VSD repair.

Perspective: CMR complemented echo by additional VSD visualization, infarct assessment and shunt calculation. Using spoiled gradient echo (instead of SSFP) cines aids looking for jets in many clinical circumstances, in this case from a VSD

Equipment: 1.5T magnetom Symphony, Siemens

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