LPAStenosis

Congenital Heart Disease Switch Operation due to Transposition of the Great Arteries	published January 16., 2002
	This 7 year old infant had undergone an arterial Switch Operation of the great arteries in 1994. At the same time, a ballon PTA was carried out successfully to dilate a severe stenosis of the right branch of the pulmonary artery. However, the left side stenosis could not be dilated successfully. In the year 2002 the boy is doing well and has no specific cardiac complaints. A transthoracic echocardiography did non show any abnormality, however, there was a suspicion of persistent stenosis in the right pulmonary artery. The boy was then referred to our institution for a more precise workup of the severity of the stenosis in the right pulmonary artery.
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First pass angiography with large volume and repetition time of 30 ms. This is a kind of Bolus tracking sequence. In this case, it showed a nicely depicted stenosis of the left pulmonary artery, but a symmetrical perfusion of both lungs, suggesting a non critical stenosis
Here, during a breath hold of 20 sec and on behalf of 1.5 mm thick slices placed through out the chest, the Gd-Bolus was imaged with timing for the pulmonary artery. The RPA stenosis is clearly visible.
Phase contrast angiography without contrast media is another tool to verify the significance of a vascular stenosis in congenital heart disease. In this case, also planimetry of the most severe vessel narrowing could be performed (RPA 7x8 mm), and peak velocity using FLOW Software from Medis.NL showed a value of 220 cm/s.
Heart function showed normal values for both ventricles, without any signs of right ventricular hypertrophy due to possible pressure overload.
Thus, in this case, further invasive evaluation and intervention could be avoided on behalf of CMR scanning. The patient was imaged during 75 minutes. His major uncomfort was due to the need for venous cannula insertion into his antecubital vein.