25 year old male with Tetralogy of Fallot, Absent pulmonary valve. Status post bioprosthetic pulmonary valve replacement in 2001. Referred for a research protocol cardiac MRI to evaluate right ventricular volume and pulmonary regurgitation. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 108 ml/m2 (normal range: 74+/-15), the LVEDV is 164 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 62 g/m2 (normal range 85+/-15), and the LV mass is 94 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is septal flattening during diastole, suggesting elevated right ventricular diastolic pressure.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 148 ml/m2 (normal range 82+/-16), the RVEDV is 224 ml (normal range 142+/-31), the RV end systolic volume index is 81 ml/m2 (normal range 31+/-9), and the RVESV is 123 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately enlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The right coronary cusp appears mildly thickened, but moves freely.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThere is a prosthetic pulmonary valve in place, with moderate stenosis and severe insufficiency.Peak velocity is 3.2 m/s, suggesting peak systolic gradient of 41 mmHg.Pulmonic regurgitant fraction at the level of the valve could not be calculated accurately due to artifact associated with the prosthetic valve.RPA flow 48 mL (5 mL regurgitation)LPA flow 32 mL (18 mL regurgitation)Regurgitant fraction based on branch pulmonary artery measurements is 29%, which may underestimate the regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch. The left carotid arises from a common trunk with the innominate artery. The aortic root is normal in size.Aortic annulus 28 mmAortic Sinuses 42 mm x 44 mm (Z-score +5)S-T Junction 34 mm x 34 mmTransverse arch 21 mm x 21mmProximal descending aorta 17 mm x 18 mmDescending aorta at diaphragm 16 mm x 16mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.MPA 39 mm x 42 mmRPA 31 mm x 37 mmLPA 31 mm x 38 mmVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.
1. Mildly dilated left ventricle, with normal systolic function.2. Severely dilated right ventricle with mildly reduced systolic function. (RVEDV 148 mL/m2, RVEF 45%)3. Severe regurgitation of prosthetic pulmonary valve.4. Severely dilated aortic root.5. Severely dilated main and branch pulmonary arteries.