A 53 year-old female with tetralogy of Fallot repaired at the age of 4 years, paroxysmal SVT, a recent echocardiogram showed enlarged right ventricle with decreased systolic function and significant pulmonic regurgitation. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with preserved systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 55 ml/m2 (normal range: 65+/-11), the LVEDV is 85 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 40 ml (normal range 31+/-10), the LV mass index is 32 g/m2 (normal range 67+/-11), and the LV mass is 50 g (normal range 114+/-24). There is localized area of hypokinesis in the mid-anterior wall which appears to be associated with a focal transmural area of late gadolinium enhancement that could suggest the presence of an underlying fibrosing or infiltrative myopathy. No thrombus was noted. Left AtriumThe left atrium is normal in size. The right atrium is severely enlarged. There is a secundum type atrial septal defect with predominantly from left to right flow. The diameter of the defect is about 11 mm on cine images.Right VentricleThe right ventricle is severely dilated with moderately reduced systolic function. The overall RV ejection fraction is 39%, the RV end diastolic volume index is 127 ml/m2 (normal range 69+/-14), the RVEDV is 196 ml (normal range 110+/-24), the RV end systolic volume index is 77 ml/m2 (normal range 22+/-8), and the RVESV is 120 ml (normal range 35+/-13). Aortic ValveThe aortic valve 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 opens widely, no stenosis was seen. There is moderate pulmonic regurgitation. Regurgitant volume is 22 mL and regurgitant fraction 32%. Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Aortic sinus of valsalva = 36 29 mm, proximal ascending aorta = 26 x 26 mm, distal ascending aorta = 23x 23 mm and descending aorta = 17 x 16 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery measures 35 x 25 mm. The left branch PA has an ostial narrowing which measures 14 x 20 mm with a more distal measurement of 24 x 23 mm.The right branch PA measures 20 x 21 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. The left ventricle is normal in size with preserved systolic function, the LVEF is 52%. There is a localized area of outpouching in the mid-distal anterior wall which appears to be associated with a small area of late gadolinium enhancement. The significance of this finding is unclear. 2. The right ventricle is severely dilated with moderately reduced systolic function The ejection fraction is 37% and the RV end-diastolic volume (indexed) was measured to be 127 ml/m2 on this study3. There is a secundum-type atrial septal defect with predominantly left to right flow. The rims of this defect appear adequate.4. The pulmonic valve opens widely, no stenosis was seen. There is moderate pulmonic regurgitation. 5. There appears to be ostial narrowing of the left PA with post narrowing dilatation. Dimensions are given above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.