76 year old man with bioprosthetic AVR and CABG. Referred to assess for change in ascending aorta dilation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 166 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 76 ml (normal range 47+/-19), the LV mass index is 31 g/m2 (normal range 85+/-15), and the LV mass is 60 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a transmural area of late gadolinium enhancement in the basal inferior and inferolateral walls. The pattern is consistent with prior myocardial infarction. These segments are not likely to be viable. There is no evidence of other late gadolinium enhancement and the remainder of the myocardium is viable. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 72 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveA bioprosthetic valve is noted in the aortic position. Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The ascending aorta is aneurysmal (fusiform). The dimensions are:Ascending aorta: 46x41mmProximal Arch: 34x34mmMid Arch: 30x33mmDescending Aorta: 29x27mmPulmonary 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 obvious pericardial disease.Extracardiac FindingsSternal wires are noted, surgical bypass clips are noted. Elevated right hemi-diaphragm with colonic interposition between the diaphragm and liver as an anatomic variant. 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. Normal left size with normal systolic function (LVEF 55%) with evidence of a transmural myocardial infarction involving the basal inferior and inferolateral walls.2. Normal right ventricular size and systolic function (RVEF 53%).3. Ascending aortic aneurysm with a maximum diameter of 46mm, which is slightly larger when compared to the CMR study from 1/14/2015. 4. Bioprosthetic aortic valve noted. 5. See extra-cardiac findings. 