37 year old female with a history of congenital pulmonary valve stenosis, status post surgical valvotomy as an infant. Referred for research cardiovascular MRI to evaluate right ventricular volume and pulmonary valve function. Patient is referred for a limited cardiac MRI as part of a clinical trial. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 70 ml/m2 (normal range: 65+/-11), the LVEDV is 110 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 41 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 69 g (normal range 114+/-24). There is diastolic flattening of the interventricular septum, suggesting increased RV volumes.AtriaThe left atrium is normal in size. Normal right atrial size. No obvious inter-atrial septal defect; however, first pass contrast imaging was not performed. Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 128 ml/m2 (normal range 69+/-14), the RVEDV is 201 ml (normal range 110+/-24), the RV end systolic volume index is 56 ml/m2 (normal range 22+/-8), and the RVESV is 87 ml (normal range 35+/-13). The shape of the right ventricle is distorted by the pectus excavatum of moderate severity (Smallest AP dimension = 78mm). There is no evidence of hemodynamic significance of the distorted RV shape. The RV outflow tract is aneurysmal.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 leaflets are thickened and trileaflet; however, they open widely. MPA is mildly dilated, measuring 33 mm. There is severe pulmonic regurgitation.Forward flow volume: 106 mLRegurgitant flow volume: 40 mLRegurgitant fraction: 38%Pulmonary Arteries:Branch pulmonary arteries are normal in size, with no evidence of stenosis.RPA 15 mm, LPA 16 mm.RPA received 45% of forward flow.LPA received 55% of forward flow.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsTrace pleural effusions. Pectus excavatum 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 left ventricular size and systolic function (LVEF 63%)2. Severely dilated right ventricle with normal systolic function (RVEDVi 127 mL/m2, RVEF 56%). 3. The right ventricular outflow tract is aneurysmal. 4. The shape of the right ventricle is distorted by the pectus excavatum of moderate severity. There is no evidence of hemodynamic significance of the distorted RV shape.5. Thickened pulmonic valve leaflets with severe pulmonic regurgitation. 6. Mild dilation of the main pulmonary artery.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.