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MR findings in Shone's complex of left heart obstructive lesions
K J Roche1, N B Genieser, M M Ambrosino
1Department of Radiology, New York University Medical Center, Tisch Hospital, Rm. 236, 560 First Ave., New York, NY 10016, USA.
Insights
Magnetic resonance (MR) imaging effectively evaluates Shone's complex, a congenital heart condition. While MR can characterize coarctation of the aorta and subaortic stenosis, it struggles with mitral valve abnormalities and thin leaflets.
Area of Science:
- Cardiovascular Imaging
- Congenital Heart Disease
- Magnetic Resonance Imaging
Background:
- Shone's complex involves four left-sided cardiac obstructions: supravalvular mitral ring, parachute mitral valve, subaortic stenosis, and coarctation of the aorta.
- Both complete and incomplete forms of Shone's complex exist, presenting diagnostic challenges.
Observation:
- This study retrospectively reviewed MR examinations in three patients diagnosed with Shone's complex (one complete, two incomplete).
- The objective was to assess the capability of MR imaging in characterizing the diverse abnormalities associated with Shone's complex.
Findings:
- MR imaging successfully demonstrated subaortic narrowing and coarctation of the aorta (both focal and diffuse).
- Abnormal mitral valve flow, leaflet motion, and papillary muscle abnormalities were identified.
- However, MR had limitations in resolving supravalvular mitral rings, individual chordal attachments, and thin subaortic diaphragms.
Implications:
- Magnetic resonance imaging is a valuable tool for evaluating patients with Shone's complex.
- Despite limitations in visualizing fine structures, MR provides crucial information for diagnosis and management of this complex congenital heart defect.
Background:
Shone's complex is a series of four obstructive or potentially obstructive left-sided cardiac lesions (supravalvular mitral ring, parachute deformity of the mitral value, subaortic stenosis, and coarctation of the aorta). Both the complete form (all four lesions) and incomplete forms (less than four lesions) have been described.
Objective:
To determine which abnormalities of Shone's complex could be characterized by MR.
Materials And Methods:
MR examinations in three patients (one complete, two incomplete) were retrospectively reviewed.
Results:
A supravalvular mitral ring, found at surgery in one patient, was not identified. Regurgitant and stenotic flow across the mitral valve, abnormal motion of the valve leaflets and abnormalities of the papillary muscles were identified. Individual chordal attachments were difficult to resolve. Narrowing in the subaortic region and abnormal flow from the subaortic region through the valve plane were demonstrated. A discrete subaortic diaphragm in one patient was not resolved. Both focal and diffuse types of coarctation of the aorta were well characterized.
Conclusion:
MR imaging is suited to evaluation of patients with Shone's complex. Individual chordal attachments and thin diaphragms of the mitral and aortic valves were difficult to resolve.
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