14 year old female with congenital pulmonic valve stenosis s/p valvuloplasty and atrial septal defect s/p percutaneous closure. Patient referred to assess for severity of pulmonic regurgitation and RV size and function. Left VentricleThe left ventricle is normal in size and sytolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 64 ml/m2 (normal range: 65+/-11), the LVEDV is 109 ml (normal range 109+/-23), the LV end systolic volume index is 29 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 41 g/m2 (normal range 67+/-11), and the LV mass is 71 g (normal range 114+/-24). There is diastolic flattening of the interventricular septum suggesting RV volume overload.Left AtriumThe left atrium is normal in size. The LA volume is 51 ml. There is evidence of an helix ASD closure.Right VentricleThe right ventricle is normal in size (but significantly larger than the LV) with mildly reduced systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 147 ml (normal range 110+/-24), the RV end systolic volume index is 50 ml/m2 (normal range 22+/-8), and the RVESV is 85 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size (67ml). 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 has thickened leaflets but opens widely. There is moderate to severe pulmonic regurgitation. The regurgitant fraction is 39% and the regurgitant volume is 32ml.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.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. The RPA is normal in size (15mm) and the LPA is mildly narrowed (10mm) without evidence of flow acceleration.Venous 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 55%).2. The RV volume is normal in absolute terms; however, it is significantly larger than the LV. The systolic function is mildly reduced (RVEF 42%). 3. Normal biatrial size with evidence of an ASD closure device.4. Pulmonic valve leaflets thickened but with normal leaflet excursion. Moderate to severe pulmonic regurgitation.5. Moderate tricuspid regurgitation. 6. Mild left pulmonary artery stenosis without evidence of flow acceleration suggesting that the stenosis is not hemodynamically significant. 