23 year old woman with shortness of breath when lying on right side and possible shunt noted on echo. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 81 ml/m2 (normal range: 65+/-11), the LVEDV is 140 ml (normal range 109+/-23), the LV end systolic volume index is 38 ml/m2 (normal range 18+/-5), the LVESV is 65 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 76 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is an atypical pattern of late gadolinium enhancement involving the basal inferior and inferolateral walls. The pattern spares the endocardium and is not consistent with prior myocardial infarction. It suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process, such as prior myocarditis. No ventricular septal defect is noted.Left AtriumThe left atrium is normal in size. No atrial septal defect are noted. The inter-atrial septum is deviated to the right, suggesting increased left atrial pressures. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVEDV is 161 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 68 ml (normal range 35+/-13). There is extrinsic compression of the right ventricular outflow tract by the below described anteriorly-located esophagus. There is no obvious evidence of flow acceleration in the RVOT to suggest that the compression is hemodynamically significant; however, correlation with Doppler echo is suggested. Right AtriumThe right atrium is normal in size. 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. There is a modest amount of mitral valve billowing. 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 VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (30 mm).Venous AnatomyThe right-SVC and IVC are normal in size and drain normally into the right atrium. A large hepatic vein travels anteriorly over the dome of the liver into the IVC , rather than through the hepatic hilum. There is a persistent left SVC which drains into the coronary sinus. ShuntNo atrial septal defect, ventricular septal defect, or anomalous pulmonary venous drainage is noted. There is a persistent left superior vena cava which drains into the coronary sinus, which is a normal variant. No large pulmonary AVMs are noted. The Qp/Qs is 1.05PericardiumThere is a small pericardial effusion.Extracardiac FindingsThe esophagus travels in between the heart and the sternum. It is significantly dilated and has an air-fluid level. Additionally, it appears to be extrinsically compressing on the right ventricular anterior free wall, this is related to patient's history of esophageal surgery. Trace bilateral pleural effusions are needed. This 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 low normal systolic function (LVEF 54%). There is a non-myocardial infarction pattern of late gadolinium enhancement involving the basal inferior and inferolateral walls. The pattern suggests an underlying fibrosis, inflammatory, or infiltrative process such as prior myocarditis. 2. The right ventricle is normal in size with normal systolic function (RVEF 58%). There is extrinsic compression of the right ventricular outflow tract by the anteriorly-located esophagus. There is no obvious evidence of flow acceleration in the RVOT to suggest that the compression is hemodynamically significant; however, correlation with Doppler echo is suggested. 3. There is a persistent left superior vena cava which drains into the coronary sinus (normal variant). A large hepatic vein travels anteriorly over the dome of the liver into the IVC , rather than through the hepatic hilum. 4. There is no significant shunt as suggested by Qp/Qs of 1.05. 5. Mildly dilated pulmonary artery. 6. Moderate tricuspid regurgitation. 