Magnetic resonance imaging in Bland-White-Garland syndrome

postoperative course was uneventful. The patient was discharged on the twelfth postoperative day and remained well3 months later. This case of ventricular septal defect is unique in that no direct perforation of the interventricular septum occurred. I t can be speculated that incomplete rupture originating from the left ventricular side of the posterior septum led to the dissection, with consecutive perforations toward the right ventricular side. This is supported by the finding that the sites of the perforations do not lay adjacent to each other as would otherwise be expected. It is surprising that the extent of the defect did not correlate with the severity of the symptoms and the only moderately elevated right ventricula~ pressures. Three-dimensional echo CT provided a better appreciation of the pathomorphologic mechanism (Fig. 1, right) and helped to explain this phenomenon by documenting only a small defect toward the right ventricle (Fig. 2), thus permitting only moderate left-toright shunting. The third chamber, which showed systolic enlargement, therefore acted as a pressure and volume reservoir. In conclusion, this case report documents for the first time a postischemic dissection of the interventricular septum with the development of a third chamber that communicates with both ventricles. The use of echo CT allowed complete three-dimensional representation of this defect.and provided both morphologic and functional clues that were not available by conventional echocardiographic imaging techniques. Further studies are necessary to delineate other potential implications of three-dimensional echocardiography.