41 year old male with a history of transposition of great arteries status-post Mustard/Senning procedure in infancy and status-post occlusion of baffle leak in 2011. The patient has worsening right ventricle function with symptoms including a recent history of VT storm (with multiple discharges of patient's right sided ICD). He is referred for cardiac MRI for further evaluation. Overall AnatomyDue to artifact from the patient's right sided ICD, limited protocol prioritizing LGE was performed. Dextrocardia with situs solitus. The pulmonary venous flow is directed to the TV, c/w post surgical baffling. Baffle patency / stenosis / thrombosis cannot be excluded. The morphologic left ventricle is left-sided and communicates with main pulmonary artery. The morphologic right ventricle is right sided and communicates with the aorta. These findings are c/w surgical correction of d-TGA present.Systemic Ventricle (i.e. Morphologic Right Ventricle)The right ventricle is severely dilated and hypertrophied with severely reduced systolic function. The overall RV ejection fraction is 22%, the RV end diastolic volume index is 176 ml/m2 (normal range 82+/-16), the RVEDV is 422 ml (normal range 142+/-31), the RV end systolic volume index is 136 ml/m2 (normal range 31+/-9), and the RVESV is 329 ml (normal range 54+/-17). There is no clear late gadolinium enhancement noted.Pulmonary Venous ReturnNot well visualized.Sub-Pulmonary Ventricle (i.e. Morphologic Left Ventricle)The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 44%, the LV end diastolic volume index is 82 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 111 ml (normal range 47+/-19), The interventricular septum bows into the left ventricle but does not cause an obvious obstruction to flow through the left ventricular outflow tract. There is no clear late gadolinium enhancement noted.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveNot well seenPulmonic ValveThe pulmonic valve opens widely. There is at least mild significant pulmonic regurgitation.Tricuspid ValveNot well seenPericardiumThere is no obvious pericardial disease.Extracardiac Findings . 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. Dextrocardia with situs solitus. The pulmonary venous flow is directed to the TV, c/w post surgical baffling. Baffle patency / stenosis / thrombosis cannot be excluded. The morphologic left ventricle is left-sided and communicates with main pulmonary artery. The morphologic right ventricle is right sided and communicates with the aorta. These findings are c/w surgical correction of d-TGA present.2. Due to artifact from the patient's right sided ICD, limited protocol prioritizing LGE was performed. There is no obvious delayed myocardial enhancement, although the images are limited.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.