45 year old woman with a history of an atrial septal defect and bicuspid pulmonic valve who underwent an unknown type of surgery at age 3 and then some type of pulmonic valve surgery at age 24, referred for interval follow up. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 65 ml/m2 (normal range: 65+/-11), the LVEDV is 120 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 59 ml (normal range 31+/-10), the LV mass index is 35 g/m2 (normal range 67+/-11), and the LV mass is 66 g (normal range 114+/-24). There are no regional wall motion abnormalities present, however there is abnormal septal wall motion possibly due to sternotomy. 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. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 55 ml/m2 (normal range 69+/-14), the RVEDV is 102 ml (normal range 110+/-24), the RV end systolic volume index is 23 ml/m2 (normal range 22+/-8), and the RVESV is 42 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, 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 appears to be bicuspid and dysplastic. There is mild pulmonic regurgitation (regurgitant fraction 11%). There is mild pulmonic stenosis (mean pressure gradient 8mmHg).Tricuspid ValveThe tricuspid valve opens widely. There is no significant 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 proximal main pulmonary artery is normal in size. There is mild aneurysmal dilation of the distal portion of the main pulmonary artery, 28x32 mm. The right PA size is 27x21mm. The left PA has a narrowing of the proximal portion, minimum diameter 17x14 mm. The distal LPA is normal in size and measures 23x23mm.Venous AnatomyThe SVC and IVC are drain normally into the right atrium. ShuntsThere are no obvious intracardiac or extracardiac shunts present. On first pass imaging, there is no evidence of right to left shunting at the atrial level. 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 low normal systolic function. The overall LV ejection fraction is 51%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with normal systolic function. 3. There is mild aneurysmal dilation of the distal main pulmonary artery and stenosis of the proximal left pulmonary artery, unchanged from prior MRI.4. The pulmonic valve appears to be bicuspid and dysplastic. There is mild pulmonic regurgitation (regurgitant fraction 11%). There is mild pulmonic stenosis (mean pressure gradient 8mmHg).5. No evidence of intra-cardiac shunts.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.