40 year old male with a history of bicuspid aortic valve, aortic pseudocoarctation and aneurysm with perforated ulcer who is status-post hemasheild graft placement in 10/2013. He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 194 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 98 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. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 94 ml/m2 (normal range 82+/-16), the RVEDV is 207 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 78 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.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 tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Hemashield graft noted in the descending thoracic aorta with surrounding post-operative changes, not changed in size.  The aortic dimensions are as follows: (Previous two dimensions in parentheses)  Sinus of valsalva 30x30mm (33x32mm, 31 x 31mm)Sinotubular junction 29x27mm (28x27mm, 30 x 27mm)Ascending aorta 29x31mm (32x32mm, 31 x 31mm)Proximal aortic arch 30x31mm (30x30mm, 32 x 32mm)Distal aortic arch 27x23mm (27x23mm, 25 x 24mm)Aortic graft measurements essentially unchanged. Pulmonary 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 FindingsSternal wires present. 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. The left ventricle is normal in size with normal systolic function (LVEF 67%). 2. The right ventricle is normal in size with normal systolic function (RVEF 63%). 3. Aortic measurements as above, not substantially changed compared to previous study. 