Fig. 4

A 10-day old neonate (3.6 kg) with hypoplastic left heart syndrome (HLHS) who was referred for FE-MUSIC CMR to assess pulmonary vein stenosis and to delineate intra-cardiac and extracardiac vascular anatomy prior to defining a surgical approach. His heart rate ranged from 126 to 140 beats per minute. HLHS with predominant right heart anatomy (a, multiplanar reformat) and common atrioventricular valve (black arrow) were confirmed. There were large pulmonary arteries and a diminutive aortic root (b, white arrow; aortic annulus 2.5 mm, sinotubular junction 1.2 mm) with the left main coronary artery (white arrowhead) coming off the aortic sinus. The left anterior descending artery courses between the RVOT and ventricle (c, white arrowhead). Large APCs (d and Additional file 3: Online video 4a-4b, white arrows) from the abdominal aorta were seen. The ductal arch (e) is continuous with the descending aorta. White arrow points to the innominate artery and white arrowhead points to the left pulmonary artery. No pulmonary vein stenosis. Based on the findings, the patient underwent occlusion of APCs and ductal stenting prior to proceeding with a hybrid Norwood and bilateral banding of the pulmonary arteries. Because MUSIC images provided a clear roadmap for surgery planning, our surgeons and cardiologists had a better sense of the child’s higher risk profile. MUSIC enhanced the risk discussion with the child’s parents. As a result, the decision was to palliate rather than pursue a staged operation