67 year old male with drug refractory long standing atrial fibrillation s/p ablation x 3, s/p AICD. Referred for cardiac MRI to assess pulmonary vein anatomy and left ventricular function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%. The LVEDV is 134 ml (normal range 142+/-34), the LV end diastolic volume index is 62 ml/m2 (normal range: 74+/-15), the LVESV is 54 ml (normal range 47+/-19) and the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9). The LV mass is 113 g (normal range 164+/-36) and the LV mass index is 52 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, considering limitations due tox magnetic susceptibility artifact from AICD/PM in the anterior chest wall.AICD/PM leads are noted in the right atrium and right ventricle. The distal segment of the right ventricular lead is obscured by artifact. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%. The RVEDV is 207 ml (normal range 142+/-31), RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVESV is 99 ml (normal range 54+/-17), and the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveAssessment is limited. The aortic valve is poorly visualized. Mitral ValveThere is no significant mitral regurgitation.Tricuspid ValveThere is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsThe right superior, right inferior and left inferior pulmonary veins drain normally into the left atrium without any obvious stenosis. The left superior pulmonary veins were not well visualized due to metallic susceptibility artifact. Complete assessment of the left atrium and pulmonary venous ostia is limited by artifact. Pulmonary ArteryThe main pulmonary artery is mildly dilated (33 mm).Venous AnatomyThe SVC and IVC 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.The left ventricle is normal in size with normal systolic function. LVEF 60%. 2.The right ventricle is normal in size with normal systolic function. RVEF 52%.3.Complete assessment of the left atrium and pulmonary venous ostia is limited by susceptibility artifact. The right upper, right lower and left lower pulmonary veins drain normally into the left atrium. The left upper pulmonary veins were not well visualized due to AICD/PM artifact.4.There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, considering limitations of technique. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.