Case Review Session 3: Valvular Heart Disease and Flow (2020)-Elucidation of Criss-Cross Heart Physiology by Four-Dimensional Flow CMR Imaging

Elucidation of Criss-Cross Heart Physiology by Four-Dimensional Flow CMR Imaging

Video Transcription

Video Summary

A 13-year-old boy had extremely complex congenital heart disease with crisscross AV relations, transposition, VSD, and Fontan palliation. Standard imaging was limited by metallic artifact, so 4D flow MRI was used to clarify the physiology. It showed right atrium to right ventricle flow to the aorta, left atrium to left ventricle flow crossing a restrictive VSD, and regurgitation through straddling tricuspid valve tissue into the right atrium. These findings were later confirmed during heart transplantation. The case highlights how 4D flow CMR can reveal unusual flow patterns and complement conventional imaging in complex congenital heart disease.

Keywords

congenital heart disease

4D flow MRI

Fontan palliation

transposition of the great arteries

ventricular septal defect