房间隔缺损伴右至左分流无肺动脉高压

Q4 Medicine

JACC. Case reports Pub Date : 2025-06-25 DOI:10.1016/j.jaccas.2025.103853

Ryusuke Sekii MD , Shingo Kato MD, PhD , Naoki Nakayama MD, PhD , Kazuki Fukui MD, PhD , Masanori Ito RT , Tae Iwasawa MD, PhD , Masaaki Konishi MD, PhD , Daisuke Utsunomiya MD, PhD , Kiyoshi Hibi MD, PhD

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引用次数: 0

摘要

四维流动磁共振成像（MRI）增强了对复杂心血管疾病的评估。我们使用MRI和先进的成像方式评估右至左分流通过房间隔缺损无肺动脉高压（PH）。病例总结：一名84岁女性，持续低氧血症，发现有明显的右至左分流，无ph。计算机断层血管造影显示严重的主动脉扭曲压迫右心房，可能导致持续分流。四维血流MRI显示分流，定量的Qp/Qs比为0.61，与有创测量一致。与典型的肺动脉-正氧综合征不同，即使在仰卧位时，极端的主动脉扭曲也可能导致持续的右至左分流。本病例强调了与年龄相关的解剖改变如何导致心内分流，并强调了先进成像的实用性。由于解剖因素，没有PH的右至左分流可能持续存在。本病例通过综合影像学包括4维血流MRI得到正确诊断。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Atrial Septal Defect With Right-to-Left Shunt Without Pulmonary Hypertension

Background

Four-dimensional flow magnetic resonance imaging (MRI) enhances the evaluation of complex cardiovascular diseases. We used MRI and advanced imaging modalities to assess a right-to-left shunt through an atrial septal defect without pulmonary hypertension (PH).

Case Summary

An 84-year-old woman with persistent hypoxemia was found to have a significant right-to-left shunt without PH. Computed tomography angiography revealed severe aortic tortuosity compressing the right atrium, likely contributing to continuous shunting. Four-dimensional flow MRI visualized the shunt and quantified a Q_p/Q_s ratio of 0.61, consistent with invasive measurements.

Discussion

Unlike classic platypnea-orthodeoxia syndrome, extreme aortic tortuosity may cause persistent right-to-left shunting even in the supine position. This case highlights how age-related anatomical changes contribute to intracardiac shunting and underscores the utility of advanced imaging.

Take-Home Message

Right-to-left shunting without PH can persist because of anatomical factors. In this case, a correct diagnosis was obtained through comprehensive imaging, including 4-dimensional flow MRI.

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