Answer for BIR CoW 04 Feb 2024
Patent ductus arteriosus with dilated left ventricle and aortic root and features of pulmonary hypertension
Findings
Small Patent ductus arteriosus noted measuring 4.5mm Patent ductus arteriosus at aortic orifice measures 3.8 mm and at pulmonary artery measures 3.3mm. Significantly dilated left ventricle and aortic root noted Main pulmonary artery appears dilated measuring 3.7mm reflecting pulmonary hypertension
Discussion
Cardiac MRI is well suited for the examination of PDA because it can accurately quantify and locate the shunt, and the effect of the shunt on cardiac structure and function. It is totally non-invasive and uses gadolinium contrast. MRI technique: Short and long axis SSFP images are obtained to quantify LV volumes and LV systolic function. Phase-contrast images are obtained perpendicular to the aorta just distal to the aortic valve, and pulmonary artery just distal to the pulmonary valve. For accurate results, an identically prescribed phase-contrast image of a stationary phantom is used for baseline correction of the the flow data. 3D images of the aorta are obtained after contrast administration to visualize PDA. Analysis: PDA is unique in that it is the only shunt type that gives a Qp/Qs <1, when pulmonary blood flow is increased. This is an artifact where on typically quantifies Qp and Qs with MRI. Qp is typically measured in the main pulmonary artery just distal to the pulmonic valve, which is proximal to the site where the PDA inserts into the main pulmonary artery. As a result, Qp does not reflect the additional pulmonary blood flow that comes from the aorta. However, Qs . The best way to determine the shunt volume is by calculating Qp/Qs using the aortic (Qs) and pulmonary artery (Qp) flows. The severity of PDA can be quantified in terms of Qp/Qs. Surgery is generally reserved for patients with Qp/Qs > 1.5, unless they are going for cardiac surgery for other reasons.
Findings
Small Patent ductus arteriosus noted measuring 4.5mm Patent ductus arteriosus at aortic orifice measures 3.8 mm and at pulmonary artery measures 3.3mm. Significantly dilated left ventricle and aortic root noted Main pulmonary artery appears dilated measuring 3.7mm reflecting pulmonary hypertension
Discussion
Cardiac MRI is well suited for the examination of PDA because it can accurately quantify and locate the shunt, and the effect of the shunt on cardiac structure and function. It is totally non-invasive and uses gadolinium contrast. MRI technique: Short and long axis SSFP images are obtained to quantify LV volumes and LV systolic function. Phase-contrast images are obtained perpendicular to the aorta just distal to the aortic valve, and pulmonary artery just distal to the pulmonary valve. For accurate results, an identically prescribed phase-contrast image of a stationary phantom is used for baseline correction of the the flow data. 3D images of the aorta are obtained after contrast administration to visualize PDA. Analysis: PDA is unique in that it is the only shunt type that gives a Qp/Qs <1, when pulmonary blood flow is increased. This is an artifact where on typically quantifies Qp and Qs with MRI. Qp is typically measured in the main pulmonary artery just distal to the pulmonic valve, which is proximal to the site where the PDA inserts into the main pulmonary artery. As a result, Qp does not reflect the additional pulmonary blood flow that comes from the aorta. However, Qs . The best way to determine the shunt volume is by calculating Qp/Qs using the aortic (Qs) and pulmonary artery (Qp) flows. The severity of PDA can be quantified in terms of Qp/Qs. Surgery is generally reserved for patients with Qp/Qs > 1.5, unless they are going for cardiac surgery for other reasons.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!