15 year old with history of tetrology of fallot requiring multiple cardiac surgeries presenting for cardiac evaluation. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 81 ml/m2, the LVEDV is 135 ml, the LV end systolic volume index is 39 ml/m2, the LVESV is 65 ml. There is a "D" sign in systole consistent with right ventricular overload, otherwise normal left ventricular wall motion. No residual VSD was noted.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly-moderately enlarged with moderately reduced systolic function. There is right ventricular hypertrophy. The overall RV ejection fraction is 29%, the RV end diastolic volume index is 117 ml/m2 , the RVEDV is 195 ml, the RV end systolic volume index is 84 ml/m2, and the RVESV is 139 ml .Right AtriumThe right atrium is mildly enlarged.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 ValveThere is a bioprosthetic valve in the pulmonary position, there is moderate-severe pulmonic regurgitation, quantified at a regurgitant fraction of 31% and 37% using 2 different methodologies. 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 mildly dilated (37mm x 34mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is poorly visualized due artifact from the PV prothesis. LPA and RPA visualized. There is artifact in the right pulmonary artery likely due to known RPA stent. Venous AnatomyThe SVC and IVC drain normally into the right atrium. There is no anomalous drainage seen. Calculated Qp/Qs is within normal limits. 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. Low normal LV EF2. Dilated RV with reduced RV EF of 29%3. PV prothesis with moderate - severe PR 4. RPA stentI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.