74 year old woman with AF, referred for evaluation of function prior to ablation. Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 25%, the LV end diastolic volume index is 98 ml/m2 (normal range: 65+/-11), the LVEDV is 186 ml (normal range 109+/-23), the LV end systolic volume index is 74 ml/m2 (normal range 18+/-5), the LVESV is 139 ml (normal range 31+/-10), the LV mass index is 53 g/m2 (normal range 67+/-11), and the LV mass is 100 g (normal range 114+/-24). There is global hypokinesis with regional variation. No evidence of myocardial iron overload. There is a moderately increased native myocardial T1 relaxation time along the mid and apical septum, suggesting the presence of fibrosis in these regions. Left AtriumThe left atrium is severely dilated. The LA volume is 219 ml.Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 26%, the RV end diastolic volume index is 121 ml/m2 (normal range 69+/-14), the RVEDV is 223 ml (normal range 110+/-24), the RV end systolic volume index is 90 ml/m2 (normal range 22+/-8), and the RVESV is 170 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. Mild aortic valve sclerosis is noted.Mitral ValveThe mitral valve leaflets are thickened and calcified with changes consistent with rheumatic mitral valve disease. The leaflet excursion is significantly restricted and suggestive of at least moderate mitral stenosis. There is additionally at least moderate mitral regurgitation. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is severe tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal 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 obvious pericardial disease. Small pericardial effusion.Extracardiac FindingsModerate right pleural effusion, small left pleural effusion. Small (<1cm) bilateral axillary lymph nodes. 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. Moderate LV dilation with severely reduced systolic function (LVEF 25%). The native myocardial T1 relaxation time is moderately elevated in the mid to apical septum suggesting the presence of fibrosis in this territory. Late gadolinium enhancement imaging was not performed given patient's renal function. 2. Moderate RV dilation with severely reduced systolic function (RVEF 26%).3. Mitral valve is thickened and calcified with changes suggestive of rheumatic mitral valve disease. The opening of the valve is restricted suggestive of at least moderate mitral stenosis. There is additionally at least moderate mitral regurgitation.4. Severe tricuspid valve regurgitation. 5. Severe biatrial dilation. 6. See extra-cardiac findings. 7. Suggest quantification of severity of valvular heart disease using echo; however, if that is not feasible for some reason, she can be brought back for additional CMR images at no charge to get extra-images needed for quantification of mitral regurgitation and mitral stenosis (Q-flow of aorta, mitral inflow, pulmonary, and planimetry of mitral orifice area at leaflet tips).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.