29 year old man with Tetralogy of Fallot s/p pulmonic valve replacement. Now with significant pulmonic valve stenosis and regurgitation, biventricular failure, and a possible RA/RV mass noted on echo. Left VentricleThe left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 26%, the LV end diastolic volume index is 111 ml/m2 (normal range: 74+/-15), the LVEDV is 254 ml (normal range 142+/-34), the LV end systolic volume index is 82 ml/m2 (normal range 25+/-9), the LVESV is 188 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 133 g (normal range 164+/-36). There is systolic flattening of the interventricular septum suggesting increased RV systolic pressure. A ventricular septal defect patch is noted in the membranous septum and there is no evidence of residual VSD. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is severely dilated and hypertrophied with severely reduced systolic function. The overall RV ejection fraction is 20%, the RV end diastolic volume index is 202 ml/m2 (normal range 82+/-16), the RVEDV is 462 ml (normal range 142+/-31), the RV end systolic volume index is 160 ml/m2 (normal range 31+/-9), and the RVESV is 368 ml (normal range 54+/-17). No mass or thrombus is noted in the RV, the finding seen on echocardiography likely represents prominent muscular bands.Right AtriumThe right atrium is severely dilated without evidence of thrombus or mass.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe bioprosthetic valve is noted in the pulmonic position. There is significant flow acceleration through the pulmonic valve consistent with at least moderate pulmonic valve stenosis. There is severe pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate to severe tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. An over-riding aorta is noted. The aortic root is dilated. The maximum dimension of the sinus of Valsalva is 39mm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated. The RPA is normal in size. The LPA is mildly dilated. Venous 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. Mild LV dilation with severely reduced systolic function (LVEF 26%). 2. Severe RV dilation and hypertrophy with severely reduced systolic function (RVEF 20%).3. Mild LA dilation4. Severe RA dilation.5. At least moderate to severe tricuspid regurgitation.6. Severe bioprosthetic pulmonic valve regurgitation with at least moderate pulmonic valve stenosis.7. Moderate dilation of the main pulmonary artery.8. Mild aortic root dilation.9. No right atrial or right ventricular mass or thrombus present. Echocardiographic findings likely represent prominent muscular bands. At the time of interpretation, the MRA and late gadolinium enhancement images were not available for review due to image transfer problems. An addendum will be added after those components are available for interpretation.