Tricuspid atresia with atrial septal defect, ventricular septal defect, and right ventricular hypoplasia demonstrated by multidetector computed tomography.

A34-year-old woman was referred to our department for evaluation of her known congenital heart disease (tricuspid atresia [TA] with an atrial septal defect [ASD] and a ventricular septal defect [VSD]). She had refused surgery in her adolescence and had since been followed up medically. A contrast enhancement CT examination using multidetector CT was performed by use of 2 methods.1–3 Figures 1 and 2 show a dynamic multislice cine scan (movie versions of Figures 1 and 2 can be found at http:// www.circulationaha.org). Dynamic data were acquired for 25 seconds with breath-hold, with a multislice cine mode in the direct 4-chamber view position (left anterior oblique with the patient lying on her back and the gantry angle adjusted). The dynamic cine mode with multidetector CT can assess flow dynamics of the contrast material in 4 slices. The TA prevented flow from the right atrium (RA) to the right ventricle (RV); the ASD allowed a “flow jet” from the RA to the left atrium (LA); and the VSD allowed flow from the left ventricle (LV) to the RV. Figures 3 and 4 show a multislice multicine scan to create 2D-CT and 3D-CT ventriculography.1–3 During a single breath-hold in the straight supine position, the patient’s entire heart was scanned with the multislice, multicine technique ([2.5 mm34 slices]310 cine scans52.5 mm340 slices, 2.5 rotations [2.0 seconds] per cine scan). With 0.1-secondframe-interval overlapping reconstruction, 16 images in different cardiac cycles were obtained per slice. Transaxial image data sets of end-diastolic (ED) and end-systolic (ES) phases were extracted to create 2D-reformation images in cardiac axes and 3D images.