39 year old male with an atrial septal defect and pulmonary hypertension, referred for cardiovascular MRI to evaluate shunt, Qp:Qs, and possible anomalous pulmonary venous return. Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. There is global hypokinesis, and diastolic septal flattening suggestive of volume overload. The overall LV ejection fraction is 28%, the LV end diastolic volume index is 125 ml/m2 (normal range: 74+/-15), the LVEDV is 227 ml (normal range 142+/-34), the LV end systolic volume index is 60 ml/m2 (normal range 25+/-9), the LVESV is 165 ml (normal range 47+/-19), the LV mass index is 70 g/m2 (normal range 85+/-15), and the LV mass is 126 g (normal range 164+/-36). There is no late gadolinium enhancement to suggest inflammatory or infiltrative disorder.Coronary ArteriesRight and left coronary artery origins are normal.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 17%, the RV end diastolic volume index is 277 ml/m2 (normal range 82+/-16), the RVEDV is 504 ml (normal range 142+/-31), the RV end systolic volume index is 230 ml/m2 (normal range 31+/-9), and the RVESV is 417 ml (normal range 54+/-17).Right AtriumThe right atrium is severely enlarged.Atrial SeptumThere is a large secundum atrial septal defect (30mm x 40mm). There is predominantly left-to-right shunting seen on the first pass perfusion imaging. Velocity-encoded imaging suggestive of bidirectional shunting although net shunt flow could not be reliably quantified. Of note, patient was on supplemental home oxygen. ASD rims: SVC rim = 12 mmIVC rim = 0-1 mmAortic rim = 11 mmPosterior rim = 11 mmAortic ValveThe aortic valve is trileaflet, opens widely, and there is trace aortic regurgitation. Aortic forward flow is 46 mL.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. It is trileaflet. There is mild pulmonic regurgitation. Pulmonary forward flow is 75 mL.Tricuspid ValveThe tricuspid valve opens widely. There is at least 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. No anomalous pulmonary venous drainage noted.Pulmonary ArteryThe main pulmonary artery is severely dilated.MPA measures 38 x 40 mmRPA measures 41 x 42 mmLPA measures 32 x 32 mmVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.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. Left ventricle is moderately enlarged with severely reduced systolic function (LVEF 28%). There is septal flattening in diastole suggestive of RV volume overload2. Right ventricle is severely enlarged with severely reduced systolic function (RVEF 14%)3. Large secundum atrial septal defect measuring 30mm x 40mm with rims as specified above. 4. Predominantly left to right shunting seen. Qp:Qs = 1.6:15. There is at least moderate tricuspid regurgitation6. No anomalous pulmonary venous drainage appreciated. 7. The main pulmonary artery and both branch PAs were severely dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.