24 year old female with a history of pulmonary valve atresia status post transannular patch and pulmonary valve replacement (bioprosthetic Carpentier-Edwards 29mm) presenting for evaluation of chamber size and function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 82 ml/m2 (normal range: 65+/-11), the LVEDV is 132 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 55 ml (normal range 31+/-10), the LV mass index is 41 g/m2 (normal range 67+/-11), and the LV mass is 66 g (normal range 114+/-24). 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 mildly reduced RV systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 144 ml (normal range 110+/-24), the RV end systolic volume index is 46 ml/m2 (normal range 22+/-8), and the RVESV is 74 ml (normal range 35+/-13). RVOT has evidence of presumed prior patch repair. Right AtriumThe right atrium is moderately enlarged. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation. The aortic valve is trileaflet.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve is consistent with a bioprosthetic valve replacement. There is mild pulmonic regurgitation present; however, correlation with echo suggested if this does not fit clinical impression given presence of significant artifact created by bioprosthetic valve. Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. No evidence of aortic aneurysm or dissection. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery and its main branches are normal in size without significant aneurysm or stenosis. Main PA - 25x28mmLPA - 24x20mmRPA - 15x17mmVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis 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 59%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size with mildly reduced RV systolic function (RVEF 49%) with evidence of likely RVOT patch repair.3. Bioprosthetic valve noted in pulmonary position with mild pulmonic valve regurgitation; however, if this finding does not fit clinical impression than correlation with echo suggested given presence of significant artifact related to presence of bioprosthetic valve.4. No significant pulmonary artery aneurysm or stenosis. 5. Moderate right atrial dilation.6. Moderate tricuspid regurgitation.7. Mild aortic regurgitation. Compared to previous study, the LV volumes are larger (both ESV and EDV) with similar ejection fraction (these changes may be related to aging), RV volumes are slightly lower with improvement in right ventricular ejection fraction. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.