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Fig. 5D —21-year-old man with criss-cross heart. One of first coronal
time-resolved angiograms (A) shows enhancement of subaortic atrium,
subaortic ventricle (saV), and aorta (Ao), indicating that systemic venous
drainage (contrast agent injection from left antecubital vein) goes directly
to systemic arterial circulation. Some seconds later, angiogram shows
enhancement of subpulmonary ventricle (spV) and pulmonary trunk (PT) caused by
large ventricular septal defect (B) (asterisk). Oblique
coronal cine view (C) verifies complex anatomy. Asterisks in A-C
show connection between subpulmonary atrium and subaortic ventricle. During
childhood patient received surgical shunt between left subclavian artery and
pulmonary artery (D) that was not detected on time-resolved MR
angiography, most likely because of small prosthesis diameter. Nevertheless,
aortic course was diagnosed as abnormal using our binary approach and
therefore high-resolution contrast-enhanced MR angiography was performed,
which allowed correct diagnosis. spA = subpulmonary atrium. See also Figure
S5, cine loop, in supplemental data online
(www.ajronline.org).
