38 years old, female, with history of dextro-transposition of the great vessels s/p Mustard procedure, who is transferred for tachy-brady syndrome. She is referred for Cardiac MRI to evaluate cardiac anatomy and function. Overall Anatomyd-TGA. There is a Mustard baffle that connects the SVC and IVC to the sub-pulmonic ventricle (i.e. morphologic left ventricle) via the mitral valve. The morphologic left ventricle communicates with main pulmonary artery. The pulmonary venous flow returns to the systemic ventricle (i.e. morphologic right ventricle) via the common atrium and tricuspid valve. The morphologic right ventricle communicates with the aorta.Systemic Venous ReturnThere is a baffle that connects the SVC and IVC to the sub-pulmonic ventricle (i.e. morphologic left ventricle) via the mitral valve. There is no obstruction or leak of the baffle noted. The IVC limb (26 mm) appears more dilated than SVC limb (12 mm).Systemic Ventricle (i.e. Morphologic Right Ventricle)The right ventricle is severely dilated and hypertrophied with severely reduced systolic function. The overall RV ejection fraction is 28.45%, the RV end diastolic volume index is 92.31 Ml/m2 (normal range 69+/-14), the RVEDV is 213.10 ml (normal range 110+/-24), the RV end systolic volume index is 66.04 ml/m2 (normal range 22+/-8), and the RVESV is 152.47 ml (normal range 35+/-13). Pulmonary Venous ReturnThere are four pulmonary veins which drain into the common atrium. There are no obvious obstructions of the pulmonary veins.Sub-Pulmonary Ventricle (i.e. Morphologic Left Ventricle)The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 43%, the LV end diastolic volume index is 55 ml/m2 (normal range: 65+/-11), the LVEDV is 127 ml (normal range 109+/-23), the LV end systolic volume index is 31 ml/m2 (normal range 18+/-5), the LVESV is 72 ml (normal range 31+/-10), the LV mass index is 26 g/m2 (normal range 67+/-11), and the LV mass is 58 g (normal range 114+/-24). The intraventricular septum bows into the left ventricle but does not cause an obvious obstruction to flow through the left ventricular outflow tract. There is subaortic/RV muscle bundles in mid cavity that may potentially obstruct if hypertrophy progresses.Common AtriumThe interatrial septum has been resected resulting in a common atrium. Aortic ValveThe aortic valve opens widely and there is minimal aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.Great VesselsThe aorta is located anterior to the pulmonary trunk. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is no thoracic aortic aneurysm or thoracic aortic dissection. The maximum diameter of the aorta is normal size. The main pulmonary artery is normal size. There are no proximal stenoses of the left and right pulmonary arteries. PericardiumThere is no obvious pericardial disease.Extracardiac Findings . 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. dTGA anatomy. 2 s/p Mustard operation.3. Unobstructed Mustard baffle without leak.4. Significant dilated sub-aortic ventricle with hypokinesis.5. No subpulmonic/subaortic stenosis.6. No aortic regurgitation.7. No LGE noted.Reviewed the study with Dr. Varga. 