50yo gentleman with a history of ischemic cardiomyopathy status post heart transplant 4/30/15, HTN, and DM presenting with fevers and L sided pleuritic chest pain now with elevated filling pressures Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 81 ml/m2 (normal range: 74+/-15), the LVEDV is 177 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 45 g/m2 (normal range 85+/-15), and the LV mass is 99 g (normal range 164+/-36). There is a septal bounce consistent with previous sternotomy. There are no other regional wall motion abnormalities present. The myocardial native T1 time is 1231ms, which is significantly elevated and suggests that there is an intra-myocardial process present.The cardiac output is 8.9L/min and the cardiac index is 4.1L/min/m2.Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 186 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 97 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace 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 combined right innominate and left common carotid or "pseudo-bovine" branching pattern, which is a normal variant. 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.PericardiumThe pericardium is thickened (7 mm maximal). The pericardium is bright on T2-weighted imaging suggesting that it is edematous/ inflamed. The pericardium is somewhat tethered to the posterior wall based on myocardial tagging. On real-time cine imaging, there is no evidence of interventricular dependence. There is a small loculated pericardial effusion adjacent to the right atrium. There is a significant amount of pericardial fat present.Extracardiac FindingsThere are sternotomy wires present. There is gynecomastia. 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 and systolic function. The overall LV ejection fraction is 54%. The native myocardial T1 time is significantly elevated suggesting that there may be an intramyocardial process present.2. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%3. The pericardium is thickened with evidence of edema/ inflammation. It is additionally tethered to the posterior wall of the myocardium. However, based on real-time cine imaging, there does not appear to be interventricular dependence. These finding suggest that there is ongoing pericarditis but the abnormality does not appear to be causing constrictive physiology.4. There is a small loculated pericardial effusion adjacent to the right atrium. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.