Fig. 1

A–M CMR revealed: Dilated RV, moderate PS (Venc = 3.5 m/s), mild PR, RF = 17%, mild AR, Qp/Qs = 1.4 denoting residual left → right shunt, dilated RA. A 49-year-old female patient, diagnosed as tetralogy of Fallot, underwent RVOT repair at age of 12-year-old. The patient was referred for RV volumes, function and Qp/Qs quantification. A Right 2-chamber cine image at diastole showing dilated, non-hypertrophied right ventricle. B, C, D, E Four sequential images right in-flow/ out-flow cine stack showing residual VSD jet. F Sagittal pulmonary phase-contrast velocity encoding sequence (in-plane, Venc 1.5 m/s); phase image showing aliasing at the pulmonary valve level requiring increasing the Venc till aliasing disappears. G Coronal pulmonary phase-contrast velocity encoding sequence (in-plane, Venc 2 m/s); phase image showing still noted aliasing at the pulmonary valve level requiring increasing the Venc till aliasing disappears. H, I Coronal pulmonary phase-contrast velocity encoding sequence (in-plane, Venc 3.5 m/s); magnitude and phase images showing disappearance of the aliasing at the pulmonary valve level denoting peak systolic velocity at this level (3.5 m/s) with pressure gradient 49 mmHg calculated by modified Bernoulli equation. J Pulmonary phase-contrast velocity encoding sequence (through-plane with Venc 3.5 m/s); phase image showing no aliasing denoting optimum Venc. K Phase-contrast velocity encoding sequence (through-plane sub-aortic level with Venc 1.5 m/s); phase image showing regurgitant blood flow for better assessment of regurgitant blood volume and therefore better assessment of regurgitant fraction, in which Qp/Qs can be calculated and found to be equal to 1.4:1 denoting left to right shunt, validating the appearance of residual VSD in the cine images. L Sagittal pulmonary cine image at diastole showing dephasing jet of pulmonary regurgitation (PR). M Feature-tracking analysis of 4-chamber cine image with endocardial contouring of dilated right atrium, RA GLS (10%) being lower than normal right atrial longitudinal strain range documented in this study (Min–Max = 22.0–54.7%)