A 14 year old female with history of transposition of the great vessels, s/p arterial switch operation and s/p repair of coarctation of aorta. Due to chest pain the patient was referred to cardiac stress MRI.MEDICATIONS: none First Pass PerfusionDuring hyperemia, no perfusion defect is noted.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe heart is mid-line, vertically oriented, and rotated counter-clockwise causing the shape of the left ventricular apex to be distorted by extrinsic compression from the sternum. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 83 ml/m2 (normal range: 65+/-11), the LVEDV is 115 ml (normal range 109+/-23), the LV end systolic volume index is 37 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 45 g/m2, and the LV mass is 63 g. Left AtriumThe left atrium is normal in size (64ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 79 ml/m2 (normal range 69+/-14), the RVEDV is 109 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 50 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is trace 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 to the left of the main pulmonary artery and both of its branches. The aorta is connected to the left ventricle, the aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is very mild narrowing of the descending thoracic aorta at the site of her coarctation procedure. There is an anomalous coronary origin noted. The right coronary artery originates from the right coronary cusp. The left anterior descending artery is a branch from the right coronary artery. It does not traverse in between the great vessels. It is unclear whether the left circumflex artery originates from the same anomalous coronary vessel or whether it originates independently from the left coronary cusp. The proximal portions of the right coronary artery and left anterior descending artery are without significant stenosis. The left circumflex is not well visualized. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is small in size (12mm). No stenosis was noted in the main PA or its major branches.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsPost surgical findings were 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. d-TGA s/p arterial switch operation. The aortic root is to the left of the main pulmonary artery and both of its major branches.2. No perfusion defects/ "ischemia" present during hyperemia.3. No prior myocardial infarction. The entire myocardium is viable.4. Normal LV size and systolic function (LVEF 55%). The left ventricular apical shape is distorted by extrinsic compression from the sternum. No evidence of underlying myocardial fibrosis, inflammation, or infiltration.5. Normal RV size and systolic function (RVEF 54%).6. Main pulmonary artery and its branches are small in caliber. 7. Anomalous coronary origin noted. The right coronary artery originates from the right coronary cusp. The left anterior descending artery is a branch from the right coronary artery. It does not traverse in between the great vessels. It is unclear whether the left circumflex artery originates from the same anomalous coronary vessel or whether it originates independently from the left coronary cusp. The proximal portions of the right coronary artery and left anterior descending artery are without significant stenosis. The left circumflex is not well visualized. 8. Minimal aortic narrowing at site of coarctation procedure. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.