Diuretic-resistant pretricuspid shunt: what is the missing link?

On admission to the regional centre, he remained in clinical right HF, blood tests were stable with haemoglobin 124 g/L, mean corpuscular volume 111 fl, creatinine 151 umol/L, total protein 61 g/L, albumin 20 g/L, estimated glomerular filtration rate 39 mL/min/1.73 m2 and a repeat 12 lead ECG (figure 1A) and TTE (figure 1B) with additional strain imaging (figure 1C) were performed. Cardiac amyloidosis Persistent left superior vena cava Cardiorenal syndrome Fabry’s disease Eisenmenger’s syndrome Answer: A The 12 lead ECG demonstrates small QRS complexes and the TTE demonstrates a dilatedcoronary sinus (CS), small global effusion, thickened atrioventricular valves, dilated atria and concentric left ventricular hypertrophy (LVH) with a ground glass appearance to the myocardium. (A) Subcostal four-chamber transthoracic scan demonstrating pericardial effusion, concentric biventricular hypertrophy, severely dilated atria and thickened atrioventricular valves with a ground glass appearance to the myocardium; (B) cMR demonstrating early nulling of the myocardium globally in a typical pattern for amyloidosis; (C) cMR demonstrating raised native myocardial T1 mapping.