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Submitted on 03 Dec 2017

Gabriele D’Ambrosio (1,2), Laura Anna Leo (2), Maria Luce Caputo (2), Francesco Fulvio Faletra (2), Maria Penco (1), Chiara Bucciarelli-Ducci (2,3)
(1) Department of Life, Health & Environmental Sciences (MESVA), University of L’Aquila, L’Aquila, Italy - (2) Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland - (3) Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust , Bristol, UK
This poster was presented at Euro CMR 2017, Prague 25-27 May 2017
Poster Views: 271
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Poster Abstract
A 80 years old male with known endovascular exclusion of aortic aneurysm was admitted to our institution
to treat an juxtarenal aortic aneurysm with a fenestrated endovascular graft. After the procedure, the
patient developed an hemorrhagic shock related to a distal renal artery perforation. The hemorrhage was
successfully managed with transcatheter selective embolization. During the shock the patient developed
a non ST segment elevation myocardial infarction (Type 2 NSTE ACS) complicated by second degree AV
block. The patient received a dual chamber Advisa™, Medtronic (a new 3 Tesla MR Conditional pacemaker)
in the right chest wall. After 6 weeks the patient underwent a full CMR protocol including cine imaging,
late gadolinium enhancement (LGE) and stress perfusion which was carried out in a 3.0T Skyra scanner
(Siemens) in order to assess inducible ischaemia and myocardial viability. The pacemaker was checked
before and after the CMR examination. Impedance, thresholds and sensing values of both atrial and
ventricular leads were good. The device was programmed in asynchronous VOO mode. After the CMR
examination the device was reprogrammed as usual. Cine GRE sequences were performed to minimize
artifacts due to the pacemaker (Figure 1). Of note, the most significant image artefact was generated by
the presence of the aortic endoprosthesis obscuring the all inferior wall. The CMR study demonstrates
a small subendocardial late enhancement of basal anterolateral wall consistent with small LCX/OM1
infarction (likely distal embolization) without evidence of inducible ischemia. The quality of the stress
CMR images was affected in the inferior wall mainly due to the presence of the aortic endoprosthesis, but
not related to the pacemaker in right side position (Figure 2).Report abuse »
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