23 year old man with dTGA s/p arterial switch operation presents with atypical chest pain and arrhythmia. He is referred for further evaluation. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 115 ml/m2 (normal range: 74+/-15), the LVEDV is 219 ml (normal range 142+/-34), the LV end systolic volume index is 63 ml/m2 (normal range 25+/-9), the LVESV is 119 ml (normal range 47+/-19), the LV mass index is 72 g/m2 (normal range 85+/-15), and the LV mass is 136 g (normal range 164+/-36). There are no regional wall motion abnormalities present; however, the LV shape is elongated. 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 mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 121 ml/m2 (normal range 82+/-16), the RVEDV is 230 ml (normal range 142+/-31), the RV end systolic volume index is 65 ml/m2 (normal range 31+/-9), and the RVESV is 123 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 mild 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 severely dilated. The remainder of the thoracic aorta is normal in size. Measurements as below. No aortic dissection is noted.Sinus of Valsalva: 50x52mmST Junction: 37x39mmAscending Aorta: 30x28mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. It is located anteriorly and to the left of the aorta. The left and right pulmonary arteries straddle over the ascending aorta. The LPA is 20mm in diameter and the RPA is 16mm in diameter. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Coronary OriginsThe left anterior descending artery originates from the left sinus. The right coronary artery originates from the right sinus. The left circumflex originates anomalously from the proximal RCA and takes the retroaortic course to the left AV groove.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. D-TGA s/p arterial switch operation.2. Mild LV dilation with mildly reduced systolic function (LVEF 46%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 3. Mild RV dilation with mildly reduced systolic function (RVEF 47%).4. The pulmonary artery is located anteriorly and to the left of the aorta. The left and right pulmonary arteries straddle over the ascending aorta. 5. Severely dilated aortic root without evidence of thoracic aortic dissection. 6. Anomalous origin of the left circumflex artery with a retro-aortic course. 