17 year old male with a history of Tetralogy of Fallot with Pulmonary atresia, status post RV to PA conduit containing a bioprosthetic pulmonary valve, and conduit replacement in 2005. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function, and global hypokinesis. There is diastolic flattening of the interventricular septum. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 179 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 89 ml (normal range 47+/-19), the LV mass index is 61 g/m2 (normal range 85+/-15), and the LV mass is 110 g (normal range 164+/-36). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. There is an RV to PA conduit anastomosis in the distal anterior wall. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 97ml/m2 (normal range 82+/-16), the RVEDV is 176 (normal range 142+/-31), the RV end systolic volume index is 49ml/m2 (normal range 31+/-9), and the RVESV is 88ml (normal range 54+/-17).Right AtriumThe right atrium is mildly enlargedMitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Coronary ArteriesBoth the right and left main coronary arteries originate from a single orifice in the right sinus of Valsalva. The left main courses anterior to the aortic valve and bifurcates to the left anterior descending and circumflex. Distal coronary arteries and posterior descending could not be visualized.Aortic ValveThe aortic valve is trileaflet, opens widely and there is mild aortic regurgitation. The angle of the LVOT and aortic valve is distorted due to the presence of the RV to PA conduit on the right side of the ascending aorta. Aortic valve annulus = 30 x 30 mmAortaThere is a left aortic arch. The aortic root and ascending aorta are moderate-severely dilated and deviated leftward due to the RV to PA conduit.Aortic Sinuses = 42 x 42 x 42 mm (Z-score +4)S-T Junction = 40 x 41 mm (Z-score +4)Ascending Aorta = 42 x 43 mm (Z-score +4)Transverse Arch = 31 x 32mmDescending aorta = 17 x 19 mmTricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitationPulmonic ValveThere is a right ventricle to pulmonary artery conduit in place, containing a bioprosthetic pulmonary valve. The conduit courses from the anterior RV wall, passing to the right of the ascending aorta to the PA anastomosis. There is an elevated trans prosthetic velocity of 2.9 m/s. No other stenosis within the conduit. Moderate pulmonary regurgitation, regurgitant fraction 23%.Pulmonary ArteryRV to PA conduit = 30 x 32 mmRPA = 10 x 13 mmLPA = 9 x 15 mmRPA receives 51% of forward flow, LPA 49%.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Venous AnatomyThe SVC and IVC 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. The left ventricle is normal in size with mildly reduced systolic function and diastolic flattening of the interventricular septum(LVEF 50%). 2. Normal right ventricular size, with mildly reduced systolic function (RVEF 49%)3. Elevated peak velocity of the valved conduit prothesis, and moderate regurgitation.4. Low-normal branch pulmonary artery dimensions with equal flow.5. Severe aortic root and ascending aorta dilation (see measurements above).6. Mild aortic insufficiency.7. Moderate TR8. Anomalous origin of the left main coronary artery, arising from the right sinus of Valsalva and coursing anterior to the aortic valve.