Male 14 years old Reason: Determine degree of RV-PA conduit obstruction History: S/p truncus arteriosus - 21 mm pericardial valve (Edward's Magna) and PA bifurcation plasty Body surface is 1.8 m2.Left VentricleThe left ventricle is enlarged. The overall LV ejection fraction is 56.9%, the LV end diastolic volume index is 123.9 ml/m2 (normal range: 74+/-15), the LVEDV is 229.8 ml (normal range 142+/-34), the LV end systolic volume index is 53.4 ml/m2 (normal range 25+/-9), the LVESV is 99.07 ml (normal range 47+/-19), the LV mass index is 73.5 g/m2 (normal range 85+/-15), and the LV mass is 136 g (normal range 164+/-36). There are no regional wall motion abnormalities present. 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. No ASD is noted after repairRight VentricleThe right ventricle is enlarged. The overall RV ejection fraction is 39.06%, the RV end diastolic volume index is 113.2 ml/m2 (normal range 82+/-16), the RVEDV is 210.3 ml (normal range 142+/-31), the RV end systolic volume index is 69.1 ml/m2 (normal range 31+/-9), and the RVESV is 120.2 ml (normal range 54+/-17). Right AtriumThe right atrium enlarged with no evidence of ASD after repair. Aortic ValveThe aortic/truncal valve opens widely. Trileaflet valve is noted. Significant regurgitant is noted as described below.Mitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta/truncus is enlarged. There is a left sided aortic arch.AORTA MEASUREMENTS: aortic valve ring: 23 mmsinuses of Valsalva: 26 mmsinotubular junction: 24 mmascending aorta: 31 mmaortic arch: 22 mmdescending aorta: 21 mmdiaphragmatic hiatus: 18 mmAORTA FLOW QUANTITATION: Stroke volume in ml: 49.8Forward flow volume in ml: 124.1Backward flow volume in ml: 74.3Regurgitant factor in %: 59.9Pulmonary ArteryThe main pulmonary artery conduit is normal in size with no evidence of strictures or calcifications. The left pulmonary artery appears to be narrowed. PULMONARY ARTERY MEASUREMENTS:MAIN: 28 mmRIGHT: 23 mmLEFT: 19 mm however the narrowest part of the left pulmonary artery adjacent to the main pulmonary activity conduit is 9.4 mm.PULMONARY ARTERIES FLOW QUANTITATION:Main pulmonary arteries flow quantitation values are as follows:Stroke volume in ml: 51.6Forward flow volume in ml: 87Backward flow volume in ml: 35.4Regurgitant factor in %: 40.7Right pulmonary artery flow quantitation values are as follows:Stroke volume in ml: 10.8Forward flow volume in ml: 16.6Backward flow volume in ml: 5.9Regurgitant factor in %: 35.3Left pulmonary artery flow quantitation values are as follows:Stroke volume in ml: 15.9Forward flow volume in ml: 35.7Backward flow volume in ml: 19.8Regurgitant factor in %: 55.5Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening but there is a small effusion.Extracardiac FindingsSternal wires are noted.
1. Status post truncus repair, VSD closure and placement of Rastelli conduit from RV to PA.2. Right and left ventricle and right atrium dilatation.3. Significant aortic regurgitation as described above.4. Left main pulmonary artery stenosis of approximately 50%5. Mild to moderate main, left and right pulmonary artery regurgitation as described above.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings.