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Abnormalities of Left Ventricular Inflow and Outflow

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Book cover Magnetic Resonance Imaging of Congenital Heart Disease

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Abstract

Congenital abnormalities of left ventricular inflow and outflow include abnormalities of the left atrium, mitral valve (supravalvar, valvar, and subvalvar), and abnormalities of the left ventricular outflow tract, the aortic valve, and supravalvar area. Cardiac magnetic resonance imaging (CMR) has become an important adjunctive tool in evaluating and following patients with this group of anomalies. This chapter reviews the role of CMR in the care of patients with congenital abnormalities of left ventricular inflow and outflow. In addition to describing the morphologic abnormalities and their clinical presentations, the indications and limitations of CMR in each condition are discussed and a suggested CMR examination protocol is provided.

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Author information

Authors and Affiliations

  1. Department of Cardiology, Harvard Medical School, Boston, MA, USA

    Puja Banka M.D.

  2. Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Puja Banka M.D.

  3. Harvard Medical School, Boston, MA, USA

    Tal Geva M.D.

  4. Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA

    Tal Geva M.D.

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  1. Puja Banka M.D.
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  2. Tal Geva M.D.
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Correspondence to Puja Banka M.D. .

Editor information

Editors and Affiliations

  1. , Stritch School of Medicine, Loyola University Chicago, S. First Ave. 2160, Maywood, 60153, Illinois, USA

    Mushabbar A. Syed

  2. Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, United Kingdom

    Raad H. Mohiaddin

9.1 Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Cor triatriatum. Cine SSFP in a 4-chamber plane showing the cor triatriatum membrane dividing the left atrium into two chambers, a proximal chamber that receives the pulmonary veins and a distal chamber that communicates with the mitral valve and left atrial appendage (not shown) (AVI 21792 KB)

Cor triatriatum In-plane cine phase contrast flow mapping in the 4-chamber plane demonstrating accelerated flow across the defect in the cor triatriatum membrane (AVI 23325 KB)

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Congenital mitral stenosis. Cine SSFP in a 4-chamber plane demonstrating a hypoplastic mitral valve annulus with thickened leaflets, restricted leaflet motion, and basal displacement of the papillary muscle. The left ventricle is also hypoplastic. Other findings include mitral regurgitation and an atrial septal defect (AVI 19296 KB)

Cleft mitral valve. Cine SSFP in a ventricular short-axis plane showing a cleft in the anterior leaflet of the mitral valve extending to the ventricular septum (AVI 34943 KB)

Cleft mitral valve. On 4-chamber view in a patient after atrioventricular canal defect repair, there is a posteriorly directed mitral regurgitation jet through residual cleft. Note also the medial tricuspid regurgitation jet (AVI 21640 KB)

Mitral valve prolapse. Cine SSFP in 4-chamber planes showing bileaflet mitral valve prolapse past the plane of the annulus and associated jet of mitral regurgitation (AVI 187456 KB)

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Mitral valve prolapse. Cine SSFP in ventricular 3-chamber planes showing bileaflet mitral valve prolapse past the plane of the annulus and associated jet of mitral regurgitation (AVI 13818 KB)

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Bicommissural aortic valve. Cine SSFP in a plane perpendicular to the aortic root demonstrating a bicuspid aortic valve with underdevelopment of the right-noncoronary commissure (AVI 20377 KB)

Bicommissural aortic valve. Cine phase contrast through-plane flow mapping perpendicular to the aortic valve demonstrating the eccentric antegrade flow jet across the bicuspid valve (AVI 16618 KB)

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Supravalvar aortic stenosis. Cine SSFP in an oblique coronal plane parallel to the left ventricular outflow tract demonstrating supravalvar aortic stenosis with narrowing at the sinotubular junction (AVI 23338 KB)

218193_1_En_9_MOESM7_ESM.avi

Aortico-left ventricular tunnel. Cine SSFP in an oblique sagittal plane parallel to the left ventricular outflow tract and proximal aorta demonstrating a defect in the aortic wall (tunnel) with flow from the ascending aorta to the left ventricle, adjacent to the aortic valve. Note the prolapsnig right coronary cusp and associated central aortic regurgitation (AVI 22289 KB)-->

Movie 9.2

Congenital mitral stenosis. Cine SSFP in a 4-chamber plane demonstrating a hypoplastic mitral valve annulus with thickened leaflets, restricted leaflet motion, and basal displacement of the papillary muscle. The left ventricle is also hypoplastic. Other findings include mitral regurgitation and an atrial septal defect (AVI 19296 KB)

Movie 9.4b

Mitral valve prolapse. Cine SSFP in ventricular 3-chamber planes showing bileaflet mitral valve prolapse past the plane of the annulus and associated jet of mitral regurgitation (AVI 13818 KB)

Movie 9.5a

Bicommissural aortic valve. Cine SSFP in a plane perpendicular to the aortic root demonstrating a bicuspid aortic valve with underdevelopment of the right-noncoronary commissure (AVI 20377 KB)

Movie 9.6

Supravalvar aortic stenosis. Cine SSFP in an oblique coronal plane parallel to the left ventricular outflow tract demonstrating supravalvar aortic stenosis with narrowing at the sinotubular junction (AVI 23338 KB)

Movie 9.7

Aortico-left ventricular tunnel. Cine SSFP in an oblique sagittal plane parallel to the left ventricular outflow tract and proximal aorta demonstrating a defect in the aortic wall (tunnel) with flow from the ascending aorta to the left ventricle, adjacent to the aortic valve. Note the prolapsnig right coronary cusp and associated central aortic regurgitation (AVI 22289 KB)-->

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Banka, P., Geva, T. (2012). Abnormalities of Left Ventricular Inflow and Outflow. In: Syed, M., Mohiaddin, R. (eds) Magnetic Resonance Imaging of Congenital Heart Disease. Springer, London. https://doi.org/10.1007/978-1-4471-4267-6_9

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  • DOI: https://doi.org/10.1007/978-1-4471-4267-6_9

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