28 year old woman with history of atrial septal defect who presents for further evaluation by cardiac MRI Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 71 ml/m2 (normal range: 65+/-11), the LVEDV is 130 ml (normal range 109+/-23), the LV end systolic volume index is 31 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 71 g/m2 (normal range 67+/-11), and the LV mass is 130 g (normal range 114+/-24). There is diastolic flattening of the interventricular septum suggesting RV volume overload. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size.Atrial SeptumA sinus venosus type atrial septal defect is noted (i.e. a communication between right superior pulmonary vein, right superior vena cava, right atrium, and left atrium). The Qp:Qs is 2.6:1. The septum bows from right to left.Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 231 ml/m2 (normal range 69+/-14), the RVEDV is 423 ml (normal range 110+/-24), the RV end systolic volume index is 104 ml/m2 (normal range 22+/-8), and the RVESV is 190 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsThe right inferior, left superior, and left inferior pulmonary veins drain normally into the left atrium. The right superior pulmonary vein is involved with the above mentioned sinus venosus type atrial septal defect.Pulmonary ArteryThe main pulmonary artery is moderately dilated in size measuring 35 mm.Venous AnatomyThe IVC drains normally into the right atrium. The right-superior vena cava is involved with the above mentioned sinus venosus type atrial septal defect. There is a persistent left-superior vena cava which drains into the coronary sinus. The coronary sinus is dilated.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.
1. The left ventricle is normal in size with systolic function (LVEF 55%)2. The right ventricle is severely dilated with normal systolic function (RVEF 57%)3. The is a sinus venosus-type atrial septal defect (i.e. a communication between right superior pulmonary vein, right superior vena cava, right atrium, and left atrium). The QP:QS is 2.6:1.4. Anomalous right superior pulmonary venous drainage.5. Persistent left sided SVC draining into the coronary sinus.6. Severe right atrial dilation7. Main PA with moderate dilation8. Moderate tricuspid regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.