38 year old male with a history of bicuspid aortic valve, aortic pseudocoarctation and aneurysm with perforated ulcer, 24mm hemashield graft to aorta in October 2013 presenting for repeat evaluation. FIrst part of the study was done May 22, 2015 but had to be aborted because patient developed a severe headache and was unable to go back into the MRI machine. Contrast had not yet been given. Patient returned on May 29 to complete the study without incident. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 192 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 128 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 91 ml/m2 (normal range 82+/-16), the RVEDV is 198 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 98 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. Aortic valve not well seen on cine imaging.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. Hemashield graft noted in the descending thoracic aorta with surrounding post-operative changes. The aortic dimensions are as follows: (Previous dimensions in parentheses) Sinus of valsalva 33x32mm (31 x 31mm)Sinotubular junction 28x27mm (30 x 27mm)Ascending aorta 32x32mm (31 x 31mm)Proximal aortic arch 30x30mm (32 x 32mm)Distal aortic arch 27x23mm (25 x 24mm)The abdominal aorta is imaged to just below the right renal artery. There is no left renal artery noted The abdominal aorta is ectatic with 4 regions of dilation. Previous measurements are in parentheses. 1. 4cm distal to the inferior border of the aortic graft measuring 35 mm (35mm) in diameter2. 10cm distal to the inferior border of the aortic graft measuring 32 mm (33mm) in diameter 3. 11cm distal to the inferior border of the aortic graft measuring 34 mm (33mm) in diameter4. 13cm distal to the inferior border of the aortic graft measuring 33 mm (33mm) in diameterPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsA midline sternotomy with post-surgical changes is noted. 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. Normal LV size and systolic function (LVEF 57%) without evidence of underlying fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 51%). 3. Aorta measurements are given above. 4. Graft noted in the descending thoracic aorta.5. Multiple ectatic areas noted in abdominal aorta. 6. No significant difference from previous study done 2014-02-04I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.