30 year old man with Tetralogy of Fallot s/p pulmonic valve replacement. Now with significant pulmonic valve stenosis and regurgitation, biventricular failure, and recent SVT. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 119 ml/m2 (normal range: 74+/-15), the LVEDV is 265 ml (normal range 142+/-34), the LV end systolic volume index is 65 ml/m2 (normal range 25+/-9), the LVESV is 146 ml (normal range 47+/-19), the LV mass index is 75 g/m2 (normal range 85+/-15), and the LV mass is 168 g (normal range 164+/-36). There is abnormal septal motion consistent with prior sternotomy. A ventricular septal defect patch is noted in the membranous septum and there is no evidence of residual VSD. There is late gadolinium enhancement of the anterior and inferior right ventricular insertion points suggesting the presence of underlying fibrosis from chronic RV pressure overload. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is moderately dilated with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 141 ml/m2 (normal range 82+/-16), the RVEDV is 316 ml (normal range 142+/-31), the RV end systolic volume index is 89 ml/m2 (normal range 31+/-9), and the RVESV is 200 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 mild thickening of the prosthetic valve leaflets without significant PS or PI.Tricuspid ValveThe tricuspid valve opens widely. There is moderate 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. A very small remnant PDA is noted. Measurements are:Sinus of Valsalva: 41x42x44mmST Junction: 40x40mmAscending Aorta: 40x40mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium. There is a left common pulmonary vein. Pulmonary ArteryThe main pulmonary artery is moderately dilated. The RPA is normal in size. The LPA is aneurysmal.MPA=33x29mmLPA=34x40mmRPA16x20mmVenous 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 mildly reduced systolic function (LVEF 45%) with evidence of fibrosis in the anterior and inferior RV insertion points likely due to chronic RV pressure overload.2. Moderate RV dilation with moderately reduced systolic function (RVEF 37%).3. Mild LA dilation4. Severe RA dilation.5. Moderate tricuspid regurgitation.6. Bioprosthetic pulmonic valve regurgitation without significant stenosis or regurgitation.7. Left pulmonary artery is aneurysmal.8. Over-riding aorta with mild aortic root dilation and mild aortic regurgitation. When compared to study from 5/2015, the pulmonic valve has been replaced and the LV/RV are improving.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.