A 13 year old female with a history of valve-sparing repair of Tetralogy of Fallot and closure of VSD. Operative notes from repair aged 10 months obtained, showing bovine monocuspid valve was positioned in the pulmonic position and a second patch to the entire main pulmonary artery, extended across the area of the annulus into the infundibulum. A small PFO was left intact. A Congenital Cardiac MRI performed on 7/8/2013 showed normal LV size and systolic function, severely dilated RV with normal systolic function, at least mild-moderate pulmonic regurgitation. Findings consistent with status post Tetralogy of Fallot repair.  Normal cardiac situs.  Normal Qp:Qs (1.27 according).Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 86 ml/m2 (normal range: 65+/-11), the LVEDV is 114 ml (normal range 109+/-23), the LV end systolic volume index is 39 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10). There is diastolic septal flattening. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No interventricular septal defect was seen.No intracavitary thrombus was seen.Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 130 ml/m2 (normal range 69+/-14), the RVEDV is 171 ml (normal range 110+/-24), the RV end systolic volume index is 60 ml/m2 (normal range 22+/-8), and the RVESV is 79 ml (normal range 35+/-13). AtriaThe left atrium is normal in size. The right atrium is severely 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 opens widely. There is at least moderate pulmonic regurgitation (regurgitant fraction 37%). No pulmonic stenosis. The subpulmonic cuff measures 13 mm diameter on dedicated 3D reconstruction views. Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root, ascending aorta, aortic arch and descending aorta are normal in size. No coarctation was seen.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryOn dedicated 3D reconstruction views, the main pulmonary artery is mildly small in calibre measuring 16 mm compared to 12 mm in the sagittal plane on previous study; differences in measurement technique likely explain the differences in quantitative size. There are postsurgical changes in the pulmonic trunk, a patch is positioned in the pulmonic position and a second patch to the entire main pulmonary artery, extended across the area of the annulus into the infundibulum.The right pulmonary artery has a diameter of 15mm. The left pulmonary artery has a diameter of 13mm.Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsIncidental note made of aberrant right subclavian artery. 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.
Compared to previous cardiac MRI from 2013, no significant changes were noted:1. Changes consistent with status post repair of Tetralogy of Fallot. 2. LV size and systolic function are normal, LVEF 55%. Previously, quantitative LVEF was calculated at 67%. Qualitatively, there is no difference in left ventricular ejection fraction implying that quantitative differences are due to different measurement technique.3. RV is severely dilated with normal systolic function, RVEF 54%. 4. There is at least moderate pulmonic regurgitation, with 37% regurgitation fraction.5. Aberrant right subclavian artery, a known aortic branch variant.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.