 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and trifurcates into the left anterior descending, ramus intermedius, and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD. The distal LAD is diminutive, the LV apex is supplied by RV acute marginal branches.Ramus intermedius: No significant stenoses.LCx: The left circumflex coronary artery is non-dominant and small. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the LCx.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery, giving rise to a large RV marginal branches (which supply the usual territory of the distal LAD, a second RV marginal branch that supplies the usual territory of the posterior descending artery), a diminutive PDA, and a posterolateral branch. There are no significant stenoses in the right coronary artery.Left VentricleThe left ventricle is normal in size. There are at least two anatomic (but not functional) ventricular septal defects. The first is located immediately proximal to the aortic valve in the usual location of the distal RVOT. The second is a muscular VSD located in the apical septum. Both VSDs have been isolated from the right ventricle by a VSD patch. There appears to be no contrast communicating between the isolated anatomical VSDs and the functional right ventricle. This explains why no turbulent jet was seen through the "VSD" on the prior cardiac MRI.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated. Not well visualized on the recent cardiac MRI, it is apparent on this study that the RV was surgically foreshortened with a patch to exclude apical muscular septal defect.Right AtriumThe right atrium is mildly dilated dilated. The right atrial appendage is located in between the left atrium and the pulmonary and aortic roots. Aortic ValveThe aortic valve is superior, anterior and to the left of the pulmonary valve.Mitral ValveThe mitral valve has no calcification.Pulmonic ValveThe pulmonic valve is normal in caliber but located to the right and posterior to the aortic root; it arises from the basal anterior wall of the right ventricle, likely via a conduit. Tricuspid ValveThe tricuspid valve has no calcification.Great VesselsMain pulmonary artery trunk (and pulmonic valve) is located along the right inferior border of the aortic root. The pulmonary artery and pulmonic valve are attached via, what is presumed to be, a short conduit to the basal free wall of the right ventricle. The distal main pulmonary artery is mildly narrowed. There are mild stenoses of the proximal right and left pulmonary arteries. Distally, the right and left pulmonary arteries are each mildly dilated. The aortic root is rotated counter-clockwise, posteriorly, and superiorly. It is likely connected to the left ventricle via an intra-ventricular baffle. The aortic arch is right-sided. The left innominate artery originates most proximally, followed by the right carotid and then right subclavian arteries. Systemic Venous ReturnRight SVC and IVC normally drain into the right atrium. A persistent left SVC courses in between the left atrial appendage and left sided pulmonary veins ultimately draining into the right atrium via a dilated coronary sinus.Pulmonary Venous ReturnAll four pulmonary veins drain into the left atrium.PericardiumThere is no obvious pericardial disease.
1.Double outlet right ventricle s/p repair. See above for details. 2.There is normal origin of the coronary arteries. There are no significant coronary artery stenoses present. The distal LAD is diminutive; however, the LV apex is supplied by large acute RV marginal branches.3. There are at least two anatomic (but not functional) ventricular septal defects. The first is located immediately proximal to the aortic valve in the usual location of the distal RVOT. The second is a muscular "VSD" located in the apical septum. Both "VSDs" have been isolated from the right ventricle by a VSD patch. There appears to be no contrast communicating between the isolated anatomical VSDs and the functional right ventricle. This explains why no turbulent jet was seen through the "VSD" on the prior cardiac MRI.4. Normal LV size.5. Moderate RV dilation.6. Persistent left sided SVC draining to coronary sinus.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.