Severe right ventricular hypertrophy in a patient with extracardiac and intracardiac shunt

Cardiac MRI is a complementary and confirmatory modality to a clinical echocardiography in diagnosing patients with complex adult congenital heart disease, especially in presence of great vessel abnormalities. We present a unique case of a patient with pulmonary hypertension ( PH ), severe right ventricular hypertrophy, Gerbode defect, and a large patent ductus arteriosus ( PDA ). The diagnosis of PDA was not visualized on prior serial echocardiograms and discovered on a comprehensive cardiac MRI /Chest MR angiogram.