58 year old with veno thromboembolic disease, HTN and aortic dilation (on CT) presenting for cardiac and aortic assessment. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 80 ml/m2 (normal range: 74+/-15), the LVEDV is 182 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 46 g/m2 (normal range 85+/-15), and the LV mass is 104 g (normal range 164+/-36). There is subendocardial late gadolinium enhancement in the base-mid inferolateral wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is consistent with myocardial infarction. There is tardo-kinesis in this area, otherwise no regional wall motion abnormalities were seen. 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 51%, the RV end diastolic volume index is 91 ml/m2 (normal range 82+/-16), the RVEDV is 205 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 100 ml (normal range 54+/-17).Right AtriumThe right atrium is not well seen.Aortic ValveThe aortic valve opens widely and there is least mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a common right innominate and left common carotid ("pseudo bovine arch", a normal variant) and normal left subclavian. The aortic root is dilated. The portion of the arch just beyond the the take-off of the branch vessels is tortuous and appears narrowed. The descending thoracic aorta is also severely tortuous. Measurements as below: Sinus of Valsalva: 42 mm x 41 mm x 41 mmSinotubular junction: 40 mm x 40 mmMaximally dilated portion of the ascending aorta: 49x50 mmMid-arch 48 x 50 mmPost-branch narrowing 29 x 24 mmDescending aorta 31 x 31 mm 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.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 and systolic function. The overall LV ejection fraction is 60%. There is subendocardial late gadolinium enhancement in the base-mid inferolateral wall which could be consistent with previous MI. 2. The right ventricle is normal in size and systolic function (RVEF 51%)3. Dilated Thoracic Aorta, measurements as above. 4. Aortic valve not well-seen on this study. Suggest transthoracic echocardiography to assess for bicuspid aortic valve and evaluate for aortic regurgitation. 