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Recent technological developments in cardiac magnetic resonance imaging (MRI) have resulted in the rapid acquisition of images of the heart with high spatial and temporal resolution and excellent myocardial tissue characterization. Cardiac MRI allows the noninvasive assessment of cardiac function, myocardial perfusion and viability, detection and characterization of inflammatory heart disease and other cardiomyopathies and congenital heart disease. This article will review the basic cardiac sequences and common indications for MRI in cardiology.

Kawasaki disease is a small-to-medium-vessel vasculitis that preferentially affects infants and young children. This condition is rare in adults, and therefore the diagnosis can easily be missed in a patient presenting to a primary care clinic. We report an unusual case of a patient who presented with ventricular fibrillation on a background of adult Kawasaki disease. To identify the advantages of using coronary multidetector computed tomography (MDCT) and cardiac magnetic resonance imaging (MRI) in diagnosing adult Kawasaki disease. We studied a 52-year-old patient with Kawasaki disease using coronary angiography, cardiac MDCT and MRI. Invasive coronary angiography demonstrated an occluded right coronary artery (RCA) and appearances suspicious for a calcified giant RCA aneurysm. The full extent of the aneurismal RCA was depicted with MDCT. Cardiac MRI revealed a chronic inferior segment myocardial infarction representing an arrhythmia substrate. Our case highlights the increasing utility of contrast-enhanced cardiac MRI and MDCT in the diagnosis of this rare condition in adults.

A 50-year-old male smoker with hypertension was brought to the emergency room by EMS. He reported several months of exertional chest pain. Over the previous week, the pain had increased in frequency; on the day of admission, it occurred while the patient was at rest. The last episode was accompanied by diaphoresis and shortness of breath. The patient was given nitrates in the ambulance and was pain free by the time of arrival at the emergency room. Physical examination was unremarkable. Electrocardiogram (ECG) showed nonspecific changes (Figure 1).

Paravalvular leaks are an uncommon but serious complication of prosthetic valves. Transthoracic echocardiography is used in the assessment of prosthetic valves but can be limited by acoustic shadowing from the prosthesis and poor acoustic windowing. Small case series have previously shown cardiac CT to have promising results in detecting paravalvular leaks. We assessed 32 valves in our institution on cardiac CT using echocardiography results as standard and developed methods for improved evaluation of prosthetic valves. These include optimizing prescan drug therapy for heart rate control, optimum window and center adjustments, and carefully selected image planes to best demonstrate the valve ring and valve annulus. Recognition of surgical material is also important to recognize. In this review, we provide a detailed description of these techniques with imaging examples of prosthetic valve evaluation using cardiac CT.

We report the radiographic, echocardiographic and cardiac CT appearances of 'porcelain heart' in an 85-year-old woman who presented with progressive heart failure. The extensive myocardial calcification was secondary to hyperparathyroidism with renal failure. 2010 Society of Cardiovascular Computed Tomography. All rights reserved.

A 40-year-old man with no cardiac history was admitted for evaluation of atypical chest pain of 1-month duration. On investigation he was found to have hypertrophic cardiomyopathy and an anomalous right coronary artery arising from the left sinus of Valsalva. This is of great clinical significance as both these conditions are independently associated with sudden cardiac death. Following extensive risk assessment and detailed discussion with the patient, he was discharged on medical therapy, comprising bisoprolol, aspirin and rosuvastatin. He has remained free of symptoms for 1 year. This report describes the rare coexistence of these two distinct clinical entities, examines the various treatment options and provides support for medical management as an acceptable treatment strategy in appropriately selected cases.

Ebstein’s anomaly (EA) is a rare cardiac congenital malformation with displacement of septal and posterior tricuspid leaflets, resulting in atrialization of the right ventricle. We report a case of EA in which the etiology of a malfunctioning prosthetic tricuspid valve is depicted on cardiac computed tomography to be as a result of thrombus lodged in the valve.

A 63-year-old man was admitted with intractable angina and underwent elective coronary angiography. He had a history of percutaneous coronary intervention to the left circumflex artery five years previously. Coronary angiography revealed 90% stenosis of the proximal right coronary artery (RCA) (Panel A) and a 3 mm Cypher stent was placed across the lesion. The procedure was complicated by a RCA dissection with retrograde extension to the ostium and subsequently into the ascending aortic wall (Panel B). The patient was referred for urgent surgical repair. Extensive bleeding was encountered at surgery, and the false lumen of …