Simple sequences for the evaluation of complex cardiopathies in resource-limited healthcare settings.

Description of Clinical Presentation: A 22-year-old female patient with a history of congenital heart disease, specifically a criss-cross heart with double outlet from the morphologic right ventricle and single ventricle physiology, previously palliated with Fontan and Glenn procedures.

Diagnostic Techniques and Their Most Important Findings: Cine imaging was performed in strict axial and sagittal planes, demonstrating dextrocardia. Two ventricles were identified: one anterior and superior, oriented from right to left, located above the second ventricle, with morphologic features of a right ventricle. This ventricle received blood from the right atrium and gave rise to both great arteries (aorta and pulmonary artery), consistent with double outlet. The second ventricle was inferior, oriented from left to right, with morphologic features of a left ventricle, and received blood from the left atrium.

Both ventricles demonstrated preserved function and were interconnected by a large muscular ventricular septal defect.

Systemic venous return was redirected surgically: inferior vena cava flow through an extracardiac conduit into the right pulmonary artery, and superior vena cava flow through a Glenn shunt also into the right pulmonary artery. Both conduits showed preserved flow, without evidence of obstruction or stenosis. The pulmonary artery was surgically occluded, with no residual flow across it. The atria were surgically connected.

Learning Points from this Case: In resource-limited public hospitals such as ours, access to advanced cardiac imaging is challenging. Utilizing available resources, such as our scanner with limited cardiac imaging tools, allows us to perform an initial evaluation in complex patients and, based on these findings, refer those who require further evaluation and management to higher-complexity centers.

A strict sagittal view showing the tricuspid valve positioned above the mitral valve.
A strict sagittal view showing the Fontan conduit with flow assessment.
A strict sagittal view showing the Glenn conduit with flow assessment.