41 year old male with history of repaired Tetralogy of Fallot who presents for cardiac MRI to evaluate for pulmonary regurgitation severity and right heart dysfunction. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 134 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 51 ml (normal range 47+/-19), the LV mass index is 50 g/m2 (normal range 85+/-15), and the LV mass is 87 g (normal range 164+/-36). Abnormal septal motion consistent with prior sternotomy is noted. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process of the LV myocardium.There is no evidence of interventricular (or interatrial) shunt by first pass perfusion.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated in size and moderately reduced in systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 155 ml/m2 (normal range 82+/-16), the RVEDV is 273 ml (normal range 142+/-31), the RV end systolic volume index is 97 ml/m2 (normal range 31+/-9), and the RVESV is 171 ml (normal range 54+/-17). The RVOT is aneurysmal with evidence of late gadolinium enhancement, most likely representing a patch-repair.Right AtriumThe right atrium is moderately dilated.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 severe pulmonic regurgitation (regurgitant volume is 65ml, regurgitant fraction is 48%)Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is an over-riding aorta. There is a right sided aortic arch with mirror imaging brachiocephalic branching pattern. The proximal portion of the left subclavian artery is not seen but the remainder of the vessel fills via collaterals, suggesting that the patient may have had a Blaylock-Taussig shunt. The aortic root is mildly dilated (sinus of Valsalva 41mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. There is mild narrowing of the proximal left (15x17mm) and right (13x17) pulmonary artery; however, there is no evidence of flow acceleration suggesting that the narrowing is not hemodynamically significant.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. The left ventricle is normal in size and systolic function (LVEF 62%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. The right ventricle is severely dilated in size and moderately reduced in systolic function (RVEF 37%). The RVOT is aneurysmal with evidence of late gadolinium enhancement, consistent with a patch repair. 3. There is severe pulmonic valve regurgitation.4. There is no evidence of residual ventricular septal defect. 5. There is mild stenosis of the right and left branch pulmonary arteries.6. The aortic root is mildly dilated. 7. There is an over-riding right sided aortic arch with mirror imaging. The proximal left subclavian artery is not seen and the vessel fills via collaterals. This suggests the patient may have had a BT shunt at one point. 