12 year old man who is s/p Tetralogy of Fallot repair with a transannular patch and monocuspid pulmonic valve. He is referred to assess for severity of pulmonic regurgitation and RV volumes and function. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 63 ml/m2 (normal range: 74+/-15), the LVEDV is 75 ml (normal range 142+/-34), the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9), the LVESV is 29 ml (normal range 47+/-19), the LV mass index is 32 g/m2 (normal range 85+/-15), and the LV mass is 39 g (normal range 164+/-36). There are no regional wall motion abnormalities present.Left AtriumThe left atrium is normal in size. A small superiorly located secundum-type atrial septal defect is noted (11x7mm).Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 117 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 69 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly 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 ValveThe pulmonic valve is thickened and calcified. There is moderate to severe pulmonic regurgitation. The regurgitant fraction is 45%. Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is an over-riding aorta. The aortic root is mildly dilated (sinus of Valsalva 34x32x32mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (19mm). The left pulmonary artery branch has an acute angled take off and is significantly narrowed (minimal diameter 5mm) with evidence of flow acceleration through the stenosis suggesting the narrowing is hemodynamically significant. The right pulmonary artery is normal in size (10mm). LPA flow 29ml (28% relative contribution) and RPA flow 75ml (72% relative contribution).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLarge thymus tissue 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 and systolic function (LVEF 61%).2 Mild RV dilation (RVEDVi 117ml/m2) with normal systolic function (RVEF 51%). 3. Mild right atrial dilation.4. Small secundum-type atrial septal defect noted.5. Pulmonic valve is thickened and calcified with severe pulmonic valve regurgitation.6. Mild to moderate tricuspid regurgitation.7. Over-riding aorta with aortic root dilation.8. Left pulmonary artery stenosis resulting in only 28% of pulmonary flow.9. See extra-cardiac findings.