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A 10 year old girl was re-evaluated for pulmonary atresia with ventricular septal defect. She had not undergone previous surgical intervention. Clinically she presented with well tolerated cyanosis. On her previous blood test, the red blood cell count was 7.4 × 1012/1 and haematocrit was 68%. Cardiac catheterisation was performed to evaluate both central pulmonary arteries and major aortopulmonary collateral arteries (MAPCA). MAPCA were well depicted but the hypoplastic central pulmonary arteries were not visualised. Three dimensional gradient echo contrast enhanced magnetic resonance angiography was then performed, using breath holding acquisition. On axial transverse reconstructions (thick slab maximum intensity projection or MIP), magnetic resonance imaging was able to detect the course of the central pulmonary main arteries, and showed the presence of the main trunk (arrow heads in left panel). In addition, right MAPCA origin was also seen in the same axial plane (straight arrow). A projectional aortogram provides excellent definition of the pulmonary vascular supply (right panel). Because the patient was clinically well, it was decided not to proceed with surgical intervention at the present time.
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