66 year old male with history of heart transplant in 9/2015 presenting for evaluation for function and evidence of rejection. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 198 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 98 ml (normal range 47+/-19), the LV mass index is 45 g/m2 (normal range 85+/-15), and the LV mass is 89 g (normal range 164+/-36). There are no regional wall motion abnormalities. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. However, native myocardial T1 and myocardial ECV fraction are both elevated suggesting underlying inflammation, fibrosis, or infiltration.Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 184 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 94 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 mild 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 normal brachiocephalic branching pattern. The aortic root is normal in size. The anastomosis of transplant and native aorta is well seen without any significant stenosis. 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 a trivial pericardial effusion. Extracardiac FindingsSternal wires are present. Right renal cyst. Can not rule out left renal mass, correlation with other imaging suggested. 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.Post transplant protocol values: Global relative enhancement 1.4 (normal < 4)T2 STIR Edema ratio 1.99 (normal < 2)Native T1 time: 1183 ms (normal < 1050ms)Extracellular volume fraction 33% (normal 20-30%)
1. The left ventricle is normal in size and low normal systolic function. The overall LV ejection fraction is 50%. There are no regional wall motion abnormalities. There is no LGE and normal myocardial global relative enhancement and T2 ratio; however, native myocardial T1 and ECV fraction are both elevated suggesting underlying myocardial fibrosis, inflammation, or infiltration. 2. The right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%.3. Mild mitral regurgitation.4. Extracardiac findings as above. Findings conveyed to referring team. 