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Gilles Soulat, Christian Latremouille, Laurence Iserin, Elie Mousseaux, Comprehensive assessment of Valsalva sinus ruptured by using 4D flow cardiac magnetic resonance, European Heart Journal - Cardiovascular Imaging, Volume 17, Issue 11, November 2016, Page 1318, https://doi.org/10.1093/ehjci/jew156
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A 41-year-old sportsman, with a known perimembranous ventricular septal defect (VSD), was admitted for severe increasing dyspnoea for more than 1 month. Transthoracic echocardiography showed a small VSD, but different merging jet flows and resting tachycardia confused Doppler analysis.
Cardiac magnetic resonance was performed at 3 Tesla (Discovery MR 750 w, GEHC). However, due to signal void related to high blood flow velocity, steady state free precession cine images were not sufficient to provide a comprehensive assessment. An 11-min 4D flow acquisition (TR 4.3, TE 1.64, FA 15°, VPS 3, 2 × 2 × 1.56 mm, venc 5 × 5 × 5 m s−1) was performed, and after cloud post-processing (Arterys©, California, USA), images showed a rupture of the right coronary sinus into the right ventricular outflow tract (Panel A, B, C, D, Supplementary data online, Movies 1 and 2). Streamlines representation was able to illustrate systole flow coming from left ventricular outflow tract (LVOT) through the rupture of the right sinus of Valsalva and going to the pulmonary trunk (Panel E). In diastole, streamlines were coming from the ascending aorta and going to the pulmonary trunk (Panel F). Furthermore, 4D flow was able to quantify flow at different levels as illustrated in Panel G, with a remarkable consistency regarding the conservation of blood flow principle. QP/QS ratio was calculated to 4.6.