67 year old woman with history of atrial fibrillation and hypertension referred for pre-ablation cardiac MRI to delineate pulmonary vein anatomy. Left VentricleThe left ventricle is normal in size with hyperdynamic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVEDV is 149 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 48 ml (normal range 31+/-10), the LV mass index is 72 g/m2 (normal range 67+/-11), and the LV mass is 161 g (normal range 114+/-24). There is eccentric hypertrophy of the left ventricle; at the base there is asymmetric hypertrophy of the septum/anterior wall, and mid chamber hypertrophy of the inferior wall. Wall motion is hyperdynamic with mid cavity obliteration and some evidence of flow acceleration in the LVOT. There are no regional wall motion abnormalities present. There is patchy late gadolinium enhancement in the septum which is associated with hypertrophy, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 1060-1070ms, which is borderline elevated. Left AtriumThe left atrium is moderate-severely dilated. No evidence of left atrial appendage thrombus. The interatrial septum bows to the right suggestive of elevated left atrial pressure.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 71 ml/m2 (normal range 69+/-14), the RVEDV is 158 ml (normal range 110+/-24), the RV end systolic volume index is 25 ml/m2 (normal range 22+/-8), and the RVESV is 56 ml (normal range 35+/-13). Right AtriumThe right atrium is mild-moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation. The leaflet tips are thickened. There is no systolic anterior motion of the mitral valve.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a pseudobovine 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. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no evidence of pericardial effusion.Extracardiac Findings 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.
1. The left ventricle is normal in size with hyperdynamic function (EF 68%). There is evidence of asymmetric/eccentric moderate hypertrophy of the basal anterior wall/septum and mid inferior wall, with mid cavity obliteration in systole and the appearance of flow acceleration in the LVOT. There is also mild patchy late gadolinium enhancement in the septal associated with areas of hypertrophy. However, there is no systolic anterior motion of the mitral valve. This is likely a hypertrophic variant and, less likely, eccentric hypertrophy due to hypertension.2. Normal size right ventricle with normal systolic function (EF 65%).3. Biatrial dilation with evidence of elevated left atrial filling pressures. 4. At least mild mitral regurgitation. 