40 year old man with tetralogy of Fallot referred for evaluation of RV size/ function and severity of pulmonic regurgitation. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 110 ml/m2 (normal range: 74+/-15), the LVEDV is 206 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 89 ml (normal range 47+/-19), the LV mass index is 72 g/m2 (normal range 85+/-15), and the LV mass is 136 g (normal range 164+/-36). There is mild hypokinesis of the mid inferior and inferolateral walls. There is a large patch repair of the membranous interventricular septum without evidence of residual ventricular septal defect. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with mild to moderately reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 224 ml/m2 (normal range 82+/-16), the RVEDV is 423 ml (normal range 142+/-31), the RV end systolic volume index is 135 ml/m2 (normal range 31+/-9), and the RVESV is 254 ml (normal range 54+/-17). The RVOT is aneurysmal consistent with outflow tract patch.Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve is trileaflet opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is severe pulmonic valve regurgitation. The regurgitant fraction is 52% and the regurgitant volume is 80ml. Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a right sided aortic arch with a mirror image 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 moderately dilated 36mm. The RPA is mild to moderately dilated (25mm) with 21ml of forward flow. The LPA is mildly narrowed (16mm) with forward flow of 23ml.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. The innominate vein travels inferior to the aortic arch before entering the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is evidence of ascites. Additionally, there is low signal of the liver on SSFP imaging which would suggest the presence of hepatic iron overload; however, dedicated T2-star iron imaging was not performed. 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. Mild LV dilation with normal systolic function (LVEF 57%) with evidence of VSD repair. There is mild hypokinesis of the mid inferior and inferolateral walls.2. Severe RV dilation with mild to moderately reduced systolic function (RVEF 40%). The RVOT is aneurysmal consistent with outflow tract repair.3. Severe right atrial dilation.4. Severe pulmonic valve regurgitation.5. The main pulmonary artery is moderately dilated. The RPA is moderately dilated and the LPA is mildly stenosed. There is equal flow to both lungs.6. Right sided aortic arch with mirror imaging and variant venous anatomy, as described above. 7. See extra-cardiac findings.