A 70 year old female with persistent atrial fibrillation and anomalous pulmonary venous connection drainage from the right lung to the superior vena cava. Referred to cardiac MRI to evaluate the anatomy before a decision about atrial fibrillation ablation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 73 ml/m2 (normal range: 65+/-11), the LVEDV is 123 ml (normal range 109+/-23), the LV end systolic volume index is 24 ml/m2 (normal range 18+/-5), the LVESV is 40 ml (normal range 31+/-10), the LV mass index is 48 g/m2, and the LV mass is 81 g. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement.There is no intracardiac thrombus.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is mildly dilated with preserved systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 100 ml/m2 (normal range 69+/-14), the RVEDV is 169 ml (normal range 110+/-24), the RV end systolic volume index is 49 ml/m2 (normal range 22+/-8), and the RVESV is 82 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Interatrial septumOn series 1501, cine imaging of 1 view (image 400) is suggestive of a small intra-atrial defect with possible left to right shunting at the expected location of the fossa ovalis. First pass imaging was performed and shunting was not demonstrated. Confirmation with echocardiography and/or contrast injection prior to atrial ablation may confirm a small defect in this location.Aortic ValveThe aortic valve is trileaflet and opens widely. There is mild aortic regurgitation visualized. Mitral ValveThe mitral valve opens widely. A small mitral regurgitation jet is visualized. This was not quantified.Pulmonic ValveThe pulmonic valve opens widely. There is no pulmonic regurgitation visualized. Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.Pulmonary ArteryThe main pulmonary artery is normal in size. The left pulmonary artery and lobar branches are normal in caliber and course. The right lobar pulmonary arteries are tortuous and small in caliber.Venous AnatomyThere is an anomalous right superior pulmonary vein that drains high into the superior vena cava. This vein is approximately 14 mm as it drains into the superior vena cava. The drainage point into the superior vena cava is approximately 1.7 cm inferior to the inflow of the right brachiocephalic vein. No additional anomalous pulmonary vein drains into the superior vena cava.The SVC and IVC are normal in size and drain normally into the right atrium. Pulmonary VeinsThe two left pulmonary veins drain normally into the left atrium. There is one normally sized superior pulmonary vein that drains into the superior left atrium. No inferior left pulmonary vein is present.Qp:QsThe calculated Qp:Qs is 1.7.PericardiumThere is no pericardial effusion.There is a focus of high signal at the infralateral pleural surface which may represent sequestration or hypoplastic right lower lobe. There is right-sided volume loss with a history of hypoplastic right lung.
1. The left ventricle is normal in size and systolic function, the LVEF is is 67%. There is no late gadolinium enhancement.2. The right ventricle is mildly dilated with preserved systolic function, the RVEF is 51%. 3. On one axial cine view, there is suggestion of a small interatrial defect with left to right shunting at the valve of the fossa ovalis. This was not well demonstrated on first pass imaging. No evidence of superior sinus venosus shunting was identified. However, in the setting of anomalous right superior pulmonary vein, a small superior sinus stenosis defect cannot be entirely excluded. Both areas of potential shunting can be further evaluated with echocardiography and/or direct contrast injection left pulmonary vein ablation. 4. The two left pulmonary veins drain normally into the left atrium. One right superior pulmonary veins drains into the superior left atrium. No right inferior pulmonary vein drains into the left atrium. There is an anomalous right superior pulmonary vein that drains high into the superior vena cava. There is a question of a right apical pulmonary AVM with a high signal focus (possible nidus) in the right apex that provides the anomalous pulmonary vein. This can be better evaluated with a CT PE thorax.7. The calculated Qp:Qs is 1.7.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.