68 year old man with remote history of colon cancer, and more recent diagnosis of carcinoid of the liver with tricuspid valve involvement and severe tricuspid regurgitation, referred for cardiac MRI as part of a pre-surgical evaluation for possible valve replacement. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVEDV is 167 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 76 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 109 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Native T1 relaxation time is 990-1020ms, which is normal. There is no evidence of myocardial iron overload. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. The interatrial septum bulges to the left, consistent with elevated right atrial pressures. Right VentricleThe right ventricle is severely dilated with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 190 ml/m2 (normal range 82+/-16), the RVEDV is 372 ml (normal range 142+/-31), the RV end systolic volume index is 102 ml/m2 (normal range 31+/-9), and the RVESV is 190 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely with trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve leaflets are thickened, calcified, with severely restricted motion, consistent with the diagnosis of carcinoid tricuspid valve disease. The tricuspid annulus is severely dilated with severe malcoaptation. There is severe tricuspid regurgitation with evidence of diastolic tricuspid regurgitation and also forward flow acceleration due to the substantial volume of TR.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 mildly dilated (34mm). Venous AnatomyThe SVC drains normally into the right atrium. The IVC is dilated.PericardiumThere is a small pericardial effusion. Extracardiac FindingsThere is hepatic vein dilation. There is a pre-tracheal calcified lymph node. 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 size left ventricle with normal systolic function (EF 55%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. Severely dilated right ventricle with mildly reduced systolic function (EF 49%). 3. The tricuspid valve leaflets are thickened, calcified, with severely restricted motion, consistent with the diagnosis of carcinoid tricuspid valve disease. The tricuspid annulus is severely dilated with severe mal-coaptation. There is severe tricuspid regurgitation with evidence of diastolic tricuspid regurgitation and also forward flow acceleration due to the substantial volume of TR.4. Mild dilation of the main pulmonary artery. 5. Severe right atrial dilation with evidence of increased RA pressures.6. Small pericardial effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.