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Number 07-20: ASD First pass contrast bolus tracking

Case from: Adam Means, Shane Chatfield, Gary R. Cooper, Pat Mergo. CMR Service, University of Florida, Gainesville, FL. USA

Clinical history: A 28 year old white male with incidental CXR abnormalities: cardiomegally, right heart enlargement and R pleural effusion
ECG: RVH
ECHO: RA and RV dilatation. RA to LA bubble transit
CMR: To confirm ASD, measure Qp/Qs and exclude other problems
Cines: RA/RV dilation, RV impairment, Secundum ASD
Cine analysis: RV SV: 147mls, LV SV: 88mls. Ratio 1.7
Axial SSFP: no PAPVR or additional forms of congenital heart disease Pleural effusions & atelectasis are seen R>L
Velocity Map: 4 chamber. Secundum ASD. Qp/Qs=1.8
First Pass Gadolinium: (with Valsalva). Prompt R to L atrial shunting - the opposite way to the rest flow and the consequent Qp:Qs

Interpretation: Secundum type ASD with shunt flow demonstrated by velocity flow map, SSFP cine, & 1st pass SA Gd perfusion during Valsalva

CMR Points: CMR localizes and quantifies secundum ASD with L to R shunt at rest, R to L during Valsalva and excludes other possible shunts

Scanner: Siemens avanto.

References: Pennell DJ et al: Clinical indications for CMR: Consensus Panel report. Eur Heart J 2004;25: 1940-65.

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