43 year old woman with history of breast cancer and dyspnea on exertion, with incidentally noted right-sided aortic arch on previous chest CT. She was referred for cardiac MRI to evaluate her aortic anatomy and for any concomitant congenital cardiac lesions. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 85 ml/m2 (normal range: 65+/-11), the LVEDV is 126 ml (normal range 109+/-23), the LV end systolic volume index is 33 ml/m2 (normal range 18+/-5), the LVESV is 50 ml (normal range 31+/-10). The wall thickness is normal. There are no regional wall motion abnormalities present. 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 normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 79 ml/m2 (normal range 69+/-14), the RVEDV is 118 ml (normal range 110+/-24), the RV end systolic volume index is 28 ml/m2 (normal range 22+/-8), and the RVESV is 42 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. No atrial septal defect is noted. 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 no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size (28mm). There is a right sided aortic arch with all for brachiocephalic vessels originating independently from the aortic arch. The most proximal vessel is the left carotid artery, followed by the right carotid and right subclavian artery. The left subclavian artery originates from the right sided descending aorta and travels posterior to the trachea and esophagus. It appears to be mildly compressing the trachea. The left coronary artery arises from the left aortic cusp, and the right coronary artery arises from the right aortic cusp.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC is normal in size and drain normally into the right atrium. The innominate vein is significantly narrowed near the junction of the SVC. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBilateral breast implants are noted. This 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. Normal LV size with normal systolic function (EF = 60%).2. Normal RV size with hyperdynamic systolic function (EF = 65%).3. Right sided aortic arch. The left subclavian artery originates from the right sided descending aorta and travels posterior to the trachea and esophagus. It appears to be mildly compressing the trachea. 4. Innominate vein is significantly narrowed at the junction of the SVC. 5. No cardiac shunts are noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.