Santens Béatrice, De Bosscher Ruben, Budts Werner, Bogaert Jan
Department of Cardiovascular Sciences, Congenital and Structural Cardiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Department of Cardiovascular Sciences, Catholic University Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Eur Heart J Case Rep. 2020 Dec 15;5(1):ytaa431. doi: 10.1093/ehjcr/ytaa431. eCollection 2021 Jan.
Right ventricular outflow tract obstruction in patients with congenital heart disease is usually assessed using echocardiographic peak instantaneous gradient at rest. Since right ventricular outflow tract obstruction may change during exercise (dynamic right ventricular outflow tract obstruction), we present a case emphasizing the potential use of exercise cardiac magnetic resonance imaging (CMR).
We discuss a 15-year-old patient with repaired mid-ventricular sub-pulmonary stenosis type double-chambered right ventricle causing right ventricular outflow tract obstruction and symptoms on exertion. In this case, exercise CMR imaging provided additional information, allowing adequate surgical planning.
The additional value of exercise CMR imaging in a case of right ventricular outflow tract obstruction was described. Although exercise cardiac magnetic resonance imaging did not show a significant increase in peak gradient across the right ventricular outflow tract obstruction, shifting and D-shaping of the interventricular septum with subsequent insufficient left ventricular filling (preload) was observed in the patient with recurrent double-chambered right ventricle. This case demonstrates how exercise CMR imaging can be helpful in the clinical decision beyond standard echocardiographic evaluation by providing additional evidence of adverse haemodynamics during exercise.
先天性心脏病患者的右心室流出道梗阻通常采用静息状态下超声心动图的峰值瞬时梯度进行评估。由于右心室流出道梗阻在运动过程中可能会发生变化（动态右心室流出道梗阻），我们报告一例强调运动心脏磁共振成像（CMR）潜在应用价值的病例。
我们讨论一名15岁患者，其已修复的心室中部肺下型狭窄（双腔右心室）导致右心室流出道梗阻并伴有劳力性症状。在此病例中，运动CMR成像提供了额外信息，有助于进行充分的手术规划。
描述了运动CMR成像在右心室流出道梗阻病例中的附加价值。尽管运动心脏磁共振成像未显示右心室流出道梗阻处峰值梯度有显著增加，但在复发性双腔右心室患者中观察到室间隔移位和D形改变，随后左心室充盈不足（前负荷）。本病例表明，运动CMR成像可通过提供运动期间不良血流动力学的额外证据，在超出标准超声心动图评估的临床决策中发挥作用。
