Multimodality Imaging of Patent Ductus Arteriosus Complicated by Severe Pulmonary Arterial Hypertension in a Pregnant Patient

Figures

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  Figure 1. Two-dimensional TTE, color-flow Doppler at the tricuspid valve level, demonstrates a regurgitant jet with a maximum velocity of 4.7 m/sec and a pressure gradient of 87 mm Hg.

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  Figure 2. Two-dimensional TTE, modified parasternal short-axis view at the level of great vessels, with color flow–guided, continuous-wave Doppler spectral signal of PDA, shows a systolic pressure of 28 mm Hg through the PDA, which correlates with an estimated RVSP of 83 mm Hg, considering a systemic blood pressure of 110/80 mm Hg at the time of the study.

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  Figure 3. Cardiovascular magnetic resonance scan, balanced steady-state free precession cine, axial plane at the level of the great vessels, demonstrates dephasing of flow going through the PDA (arrow) from the descending aorta into the main PA during midsystole. Asc Ao, Ascending aorta; Desc Ao, descending aorta.

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  Figure 4. Cardiac computed tomography of the heart and great vessels, sagittal plane, demonstrates communication between the PA and the descending aorta through the PDA (arrow). To visualize PDA, CCT was performed using the automatic bolus triggering technique for a region of interest placed in the distal main PA. Desc Ao, Descending aorta; LV, left ventricle; RVOT, RV outflow tract.

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  Figure 5. Cardiac computed tomography, three-dimensional volume-rendered images, demonstrates an anteroposterior view (A) and left lateral view (B) of the great vessels, which detail the presence of the PDA (red asterisk) and the surrounding anatomy. Asc Ao, Ascending aorta; Desc Ao, descending aorta.

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  Figure 6. Timeline of events since first contact with cardiology, to follow-up 1 year after delivery. CO, Cardiac output; IV, intravenous; mPAP, mean PA pressure; NYHA, New York Heart Association class; PO, oral; PADP, PA diastolic pressure; PCWP, pulmonary capillary wedge pressure; Qp, pulmonary flow; Qs, systemic flow; RA, right atrium; RHC, right heart catheterization; RVEDP, RV end-diastolic pressure; RVSP, RV systolic pressure; TR, tricuspid regurgitation; WU, Woods units.