Priya Sarv,  Nagpal Prashant

Final Pr. ID: Poster #: CR-002

Ectopia cordis is a rare congenital condition where the heart is located outside the chest cavity, often associated with midline defects like omphalocele and Pentalogy of Cantrell. This condition presents significant challenges in surgical management and has a high mortality rate due to complications related to cardiac and associated anomalies.

A newborn delivered at 37 weeks gestation was admitted for surgical management of ectopia cordis and omphalocele. Prenatal imaging suggested Pentalogy of Cantrell. An echocardiogram was performed, but visualization was limited due to the heart’s external position, hindering comprehensive assessment. A follow-up CT angiogram confirmed ectopia cordis with complex cardiac and vascular findings. The left-sided superior vena cava drained into the coronary sinus, and the inferior vena cava was dilated, draining into the right atrium. The right atrium was dilated, while the left atrium was elongated with normal pulmonary venous drainage. A 4 mm atrial septal defect and a possible 2 mm perimembranous ventricular septal defect were noted. The right ventricle appeared normal, but the left ventricle was hypoplastic. The aortic root and ascending aorta were hypoplastic, with Z-scores ranging from -3.20 to -4.90, while the aortic isthmus and descending aorta were within normal limits. The pulmonary arteries were normal in size, and a large PDA was observed.
3D modeling was used to assess the feasibility of surgical repair and chest closure. The heart outside the chest measured 30.65 ml, and the total intrathoracic volume was 107.31 ml. The combined volume of the lungs and pleural effusions totaled 77.69 ml, leaving limited space for the heart within the thoracic cavity. This made the prospect of repositioning the heart into the chest highly challenging, with significant risk of compressing the lungs or other critical structures. The baby passed away during the hospital stay.
This case highlights the role of CTA and 3D modeling in congenital heart disease, illustrating how these tools can assist in evaluating spatial constraints and informing surgical decisions in complex conditions like ectopia cordis. Read More

Authors:  Priya Sarv , Nagpal Prashant

Keywords:  3D Model, Pentalogy Of Cantrell, Cardiovascular

Moretti Jean-baptiste,  Alchourron Emilie,  Stein Nina,  Farhat Ziad,  Garel Juliette,  Lapierre Chantale,  Dubois Josée,  El-jalbout Ramy

Final Pr. ID: Poster #: SCI-003

Pediatric carotid artery Intima-Media Thickness (IMT) is a non-invasive ultrasound marker of early atherosclerosis. Obesity in children is associated with increased IMT. The objective of this meta-analysis is to report IMT values in children living with overweight/obesity in the literature. Read More

Authors:  Moretti Jean-baptiste , Alchourron Emilie , Stein Nina , Farhat Ziad , Garel Juliette , Lapierre Chantale , Dubois Josée , El-jalbout Ramy

Keywords:  Carotid Intima-Media Thickness, Pediatric, Cardiovascular Risk

Ordonez Alvaro,  Stecher Priscilla,  Rogers Lindsay,  Bhatti Tricia,  Noor Abass

Final Pr. ID: Poster #: CR-006

Single ventricle heart defects (SVHD) refer to a rare and diverse group of severe congenital cardiac abnormalities in which the systemic and pulmonary venous return enter a functionally single ventricular chamber. This condition is typically caused by underdevelopment of an atrioventricular valve and/or a ventricular chamber, leading to a range of complex congenital heart defects. With an incidence of approximately 3 to 5 per 10,000 live births, newborns with SVHD are critically ill, and without medical intervention, the condition is fatal. Advancements in surgical techniques, namely staged palliation and orthotopic heart transplantation, have enabled more patients with SVHD to survive into adulthood. However, despite these improvements, the perinatal period remains tenuous.

We present a five-week-old male infant born at 38 weeks of gestation with a functional SVHD in the form of severe subaortic stenosis, arcade-like mitral valve, left ventricular dilation and dysfunction, and restrictive atrial septum. He received multiple surgical interventions, including atrial septal stenting with pulmonary artery banding and stage I reconstruction with a right Blalock-Thomas-Taussig shunt. Postoperative course was complicated by delayed sternal closure, cardiac arrest, right hemidiaphragm plication, and progressive heart failure. At five weeks, CT angiography showed a functional single ventricle status post Damus-Kaye-Stansel anastomosis, hypoperfusion of the left ventricle myocardium, and pneumoperitoneum. Exploratory laparotomy with segmental bowel resection revealed perforated acute appendicitis and mucosal ulceration of the cecum. Following the procedure, he developed acute hypoxemia and bradycardia. Life-sustaining support was withdrawn. Postmortem examination of the heart was notable for severe aortic stenosis with subaortic obstruction, stenotic mitral valve with arcade-like fibrous plaques, and biventricular hypertrophy. Histopathology of the left ventricle showed significant subendocardial fibrosis without areas of myocyte injury.

Due to the complexities involved in its management, SVHD demands special attention from radiologists. While advancements in medical and surgical care have improved outcomes, ongoing progress depends on a deeper understanding of the factors contributing to ventricular dysfunction and heart failure in this vulnerable population. Read More

Authors:  Ordonez Alvaro , Stecher Priscilla , Rogers Lindsay , Bhatti Tricia , Noor Abass

Keywords:  Ventricular Dysfunction, Cardiac CTA, Cardiovascular Disease

Priya Sarv,  Narayanasamy Sabarish,  Nagpal Prashant

Final Pr. ID: Poster #: CR-002

Left ventricular diverticulum is an uncommon congenital malformation defined as a localized, contractile outpouching of the ventricular wall. It must be carefully distinguished from acquired ventricular aneurysm or pseudoaneurysm, as the diagnostic implications, management strategies, and long-term prognosis differ substantially.

A 2-month-old infant was referred for advanced imaging after transthoracic echocardiography raised concern for an abnormal left ventricular contour. Cardiac CT and MRI confirmed a discrete outpouching along the basal to mid anterolateral wall, measuring approximately 2.1 cm in maximal diameter, with a neck dimension of 13–14 mm. Myocardium was clearly present overlying the outpouching, and the structure demonstrated preserved systolic contractility synchronous with the adjacent ventricular wall. No evidence of wall thinning, akinesia, dyskinesia, or delayed gadolinium enhancement was identified. Global biventricular function was preserved, and coronary anatomy was normal.
The initial impression suggested a basal anterolateral LV aneurysm; however, the morphological and functional features, including intact myocardial layers and preserved contraction, were more consistent with a congenital LV diverticulum. Importantly, the absence of clinical history of ischemic, inflammatory, or traumatic insult supported this conclusion.
The key differential diagnoses include congenital LV diverticulum, true aneurysm, and pseudoaneurysm. Congenital diverticula are contractile and narrow-necked, maintaining myocardial continuity. True aneurysms typically follow myocardial infarction or myocarditis and demonstrate dyskinesia and wall thinning. Pseudoaneurysms result from contained rupture, are characterized by absent myocardial continuity, and frequently have a wide neck. Careful assessment of wall, contractility, and enhancement characteristics are essential for accurate classification.
On follow-up echocardiogram imaging, the diverticulum remained stable in morphology and size, without evidence of thrombus formation or functional deterioration. Conservative management with periodic surveillance was advised.
This case underscores the importance of multimodality imaging in ventricular outpouchings, demonstrating how contractile morphology and myocardial integrity support the diagnosis of congenital LV diverticulum. Precise differentiation from acquired lesions prevents misclassification, informs prognosis, and guides appropriate long-term management. Read More

Authors:  Priya Sarv , Narayanasamy Sabarish , Nagpal Prashant

Keywords:  Cardiac CTA, Cardiovascular, Congenital

Sharma Priya,  Rajderkar Dhanashree

Final Pr. ID: Poster #: EDU-117

In this exhibit we will review the multimodality imaging findings in patients with HLHS using chest radiography (CXR), computed tomography (CT) and magnetic resonance imaging (MRI). We will discuss the physiologic basis for the radiologic findings of HLHS, describe the palliative surgical procedures to correct HLHS and their complications. Read More

Authors:  Sharma Priya , Rajderkar Dhanashree

Keywords:  Hypoplastic Left Heart, Cardiovascular, Surgical Correction, HLHS

Priya Sarv,  Nagpal Prashant

Final Pr. ID: Poster #: EDU-004

This exhibit explores the microbolus injection technique in pediatric cardiac CT angiography, providing a comparison to traditional bolus and test bolus methods. The microbolus technique involves delivering multiple small, precisely timed boluses of contrast media, each followed by saline flushes, using a dual-head power injector. Unlike the standard bolus injection, which administers a single large volume of contrast, the microbolus technique dispenses several smaller doses of contrast at regular intervals, interspersed with saline. This approach synchronizes the contrast circulation with the patient’s cardiac output and vascular dynamics, ensuring enhanced opacification of key heart structures, particularly in pediatric patients. The saline flushes help maintain a steady flow and promote even distribution of the contrast, preventing pooling. The primary aim is to achieve simultaneous, uniform opacification of both right and left heart structures, including coronary arteries, pulmonary arteries, and systemic veins, all within a single scan. This precise timing and contrast distribution have the potential to reduce the need for repeat imaging caused by suboptimal visualization, thus potentially lowering radiation exposure and contrast volume.

This educational exhibit will address the following:

A comprehensive overview of the microbolus injection technique, highlighting its distinction from traditional bolus and test bolus injections.
An explanation of injector requirements and how the precise timing of contrast and saline boluses is achieved.
Potential advantages of achieving simultaneous opacification of both right and left heart structures.
The possibility of reducing the need for repeat or delayed scans, potentially decreasing radiation exposure.
A discussion of the technique's limitations and practical considerations for clinical implementation. Read More

Authors:  Priya Sarv , Nagpal Prashant

Keywords:  Cardiovascular, CT Angiography, Teaching

Priya Sarv,  Narayanasamy Sabarish,  Nagpal Prashant

Final Pr. ID: Poster #: CR-004

Transposition of the great arteries (TGA) is typically described using the prefixes “D” and “L,” based on the position of the aortic root relative to the pulmonary trunk. In current practice, these prefixes are often applied as shorthand to define specific segmental combinations, such as “D-TGA” for concordant atrioventricular and discordant ventriculo-arterial connections, or “L-TGA” for congenitally corrected variants. However, atypical and mirror-image cases challenge the accuracy of this prefix-based terminology and highlight the need for full segmental description.

A 4-year-old boy with a background of complex congenital heart disease presented for follow-up evaluation prior to surgical intervention. He had a known history of mirror-imaged visceral arrangement and had previously undergone a bidirectional Glenn shunt for palliation of pulmonary atresia, ventricular septal defect, and atrial septal defect. Cardiac computed tomography revealed mirror-imaged atrial arrangement, with the morphologic right atrium located on the left and the morphologic left atrium on the right. The thoraco-abdominal organs were similarly reversed, including a left-sided liver and right-sided stomach and spleen. The ventricles showed D-looping with right-handed topology, with the morphologic right ventricle on the right and morphologic left ventricle on the left. The aorta arose discordantly in a rightward and anterior position relative to the pulmonary trunk, consistent with transposition physiology in this mirror-image setting.
This case demonstrates the limitations of relying solely on “D” and “L” prefixes. In this patient, the aortic root position was consistent with “D-TGA” in its original spatial sense, yet the overall physiology was that of congenitally corrected transposition due to the underlying atrioventricular and ventriculo-arterial connections. Describing the case simply as “D-TGA” would be misleading and risk miscommunication in clinical and surgical planning.
This report emphasizes that accurate diagnosis and classification of TGA require comprehensive segmental analysis, including atrial arrangement, ventricular topology, and the nature of atrioventricular and ventriculo-arterial connections. The position of the aorta should be reported separately rather than equated with transposition type. Recognition of these principles is essential to avoid confusion and ensure clarity in the management of complex and mirror-image variants of congenital heart disease. Read More

Authors:  Priya Sarv , Narayanasamy Sabarish , Nagpal Prashant

Keywords:  Cardiac CTA, Complex Congenital Heart Disease, Cardiovascular

Nagy Eszter,  Wieser Clarina,  Windhaber Jana,  Kogler Kristina,  Steinberger Monika,  Sorantin Erich

Final Pr. ID: Poster #: SCI-018

Morphological and functional carotid artery alteration can occur already in youth ages, essentially in presence of cardiovascular risk factors. Studies have showed that sonographic assessment of carotid artery (CA) Intima-Media Thickness (IMT) serves as prognostic factors for cardio-vascular disease also in youth patient population. As functional changes occur earlier than vessel wall morphological changes, this might be indicated by a decrease in vessel elasticity prior to the increase of IMT. This hypothesis indicates to use an early functional parameter for cardiovascular risk assessment.
This study was designed to assess and evaluate IMT as well as CA vessel elasticity in three groups, in young sportsmen and youth volunteers without any cardio-vascular risk factors (CV-RF) comparing to youth volunteers with CV-RF. Read More

Authors:  Nagy Eszter , Wieser Clarina , Windhaber Jana , Kogler Kristina , Steinberger Monika , Sorantin Erich

Keywords:  cardiovascular risk assessment, carotid sonography

Priya Sarv,  Narayanasamy Sabarish,  Nagpal Prashant

Final Pr. ID: Poster #: CR-005

Pulmonary embolism (PE) is a potentially life-threatening condition, and accurate imaging is critical for timely diagnosis. While CT pulmonary angiography is the gold standard, MR angiography (MRA) offers a radiation-free alternative, particularly important in younger patients. However, MRA is prone to artifacts that can mimic pathology and lead to false-positive interpretations.

We present two cases of 15-year-old patients who presented to the emergency department with acute chest pain and underwent MRA as part of the diagnostic workup to avoid radiation exposure. In both cases, imaging demonstrated central dark signal voids within the pulmonary arteries, raising concern for thrombus. Closer review revealed these findings were attributable to Gibbs ringing artifact, which occurs due to undersampling and edge effects, producing alternating bright and dark bands that may simulate intraluminal filling defects. In one patient, additional challenges were posed by timing-related artifacts during k-space acquisition, where misalignment of contrast bolus and central k-space filling resulted in a “maki roll” appearance, further complicating interpretation.
Strategies to differentiate artifact from true thrombus include correlating with multiple imaging planes, and importantly, reviewing second or delayed angiographic runs to determine whether a defect persists or resolves. In both cases, the absence of persistent findings and awareness of artifact patterns prevented misdiagnosis of PE.
These cases underscore the importance of recognizing Gibbs ringing and timing-related artifacts in MRA of the pulmonary arteries. Careful image review and knowledge of common pitfalls are essential to avoid false-positive diagnoses and ensure appropriate patient management. Read More

Authors:  Priya Sarv , Narayanasamy Sabarish , Nagpal Prashant

Keywords:  Cardiovascular MRA, Magnetic Resonance Imaging, Pulmonary Embolism

Arguello Fletes Gladys,  Rodriguez Estrella Maria Alejandra,  Acosta Izquierdo Laura

Final Pr. ID: Poster #: EDU-006

Objectives
-Understand the genetic and pathophysiologic basis of the vascular disease in Williams–Beuren syndrome (WBS).
-To show our CT angiography (CTA) protocol tailored for patients with Williams syndrome, optimizing image quality and diagnostic yield while minimizing radiation and contrast exposure.
-To illustrate, through a case-based approach, the spectrum of cardiovascular abnormalities identifiable on CT angiography (CTA), emphasizing the characteristic imaging findings of supravalvar aortic stenosis (SVAS), peripheral pulmonary artery stenosis (PPS), and associated coronary, renal, and systemic arterial stenoses
-Recognize imaging pitfalls and risk features for surgical or anesthetic complication

Teaching points
-CTA provides a single comprehensive evaluation of coronary, pulmonary, systemic, and renal vasculature critical in a disorder where lesions are multifocal.
-SVAS is the dominant lesion; PPS is the most dynamic. CT differentiates between the two and maps to their extent.
-Coronary ostial stenosis is the main cause of sudden cardiac events.
-Renal and systemic arterial lesions explain hypertension and require inclusion of abdominal CTA in baseline studies.
-3D reconstructions are essential for surgical planning and multidisciplinary discussions. Read More

Authors:  Arguello Fletes Gladys , Rodriguez Estrella Maria Alejandra , Acosta Izquierdo Laura

Keywords:  Cardiovascular, 3D Images, Vascular Imaging