A 18 year old female with s/p tetralogy of Fallot repair with pulmonic valve regurgitation referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 79 ml/m2 (normal range: 65+/-11), the LVEDV is 100 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 43 ml (normal range 31+/-10), the LV mass index is 51 g/m2 (normal range 67+/-11), and the LV mass is 65 g (normal range 114+/-24). There is flattening of the interventricular septum throughout the entire cardiac cycle, greatest in diastole, suggesting a combination of elevated right ventricular pressure and volume.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with moderately reduced systolic function. The overall RV ejection fraction is 36%, the RV end diastolic volume index is 128 ml/m2 (normal range 69+/-14), the RVEDV is 163 ml (normal range 110+/-24), the RV end systolic volume index is 82 ml/m2 (normal range 22+/-8), and the RVESV is 105 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. 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 appears narrowed with antegrade susceptibility artifact during systole, indicative of accelerated antegrade flow (2101/6). There is narrowing at the valvular level measuring 11 mm in minimal diameter, noted on the RVOT view. There is moderate pulmonic regurgitation (assessed by qualitative and quantitative analyses, main pulmonary artery regurgitant fraction of 32%, right pulmonary artery regurgitant fraction of 19%, left pulmonary artery regurgitant fraction of 16%).Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is a right-sided aortic arch. The aortic root is normal in size.Duplicated superior vena cava with the left drain into an enlarged coronary sinus.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery and the right and left branches are normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsSternal wires were noted. Mid thoracic vertebral abnormalities which can be better characterized with chest radiograph.
Severe dilatation of the right ventricle reduced systolic function with ejection fraction of 36%. Well preserved left ventricular systolic function with an ejection fraction of 57%.Pulmonic regurgitation, quantified as moderate with a regurgitant fraction of 32%. There is a degree of pulmonic stenosis at the valvular level, maximum 11 mm on the sagittal view (RVOT view). There is antegrade acceleration of flow above the valve.Postsurgical findings of tetralogy of Fallot repair without evidence of significant ventricular septal defect. Duplicated superior vena cavae with right-sided aortic arch.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.