Key result
Exercise cardiac magnetic resonance imaging revealed shifting and D-shaping of the interventricular septum with insufficient left ventricular filling during exertion in a 15-year-old patient.
Why the study?
Right ventricular outflow tract obstruction in congenital heart disease is usually assessed at rest, but obstruction may change dynamically during exercise.
Does exercise cardiac magnetic resonance imaging provide additional diagnostic value for assessing dynamic right ventricular outflow tract obstruction in congenital heart disease?
Case Report (n=1)
Does exercise cardiac magnetic resonance imaging provide additional diagnostic value for assessing dynamic right ventricular outflow tract obstruction in congenital heart disease?
Exercise CMR can provide critical additional evidence of adverse hemodynamics during exertion in patients with congenital heart disease and right ventricular outflow tract obstruction, aiding in surgical planning beyond standard echocardiography.
Exercise CMR may detect dynamic RVOT obstruction missed at rest; hypothesis-generating for congenital heart disease pending prospective studies.
BACKGROUND: 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). CASE SUMMARY: 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. DISCUSSION: 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.
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Santens et al. (2020) conducted a case report in Right ventricular outflow tract obstruction in congenital heart disease (n=1). Exercise cardiac magnetic resonance imaging (CMR) was evaluated on Haemodynamic changes and peak gradient across the right ventricular outflow tract during exercise. Exercise cardiac magnetic resonance imaging revealed shifting and D-shaping of the interventricular septum with insufficient left ventricular filling during exertion in a 15-year-old patient.
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