61 year old with history of congestive heart failure and valvular heart disease requiring mitral and tricuspid valve surgery, COPD, CKD and coronary artery disease presenting for cardiac evaluation prior to implantable cardioverter defibrillator. Left VentricleThe left ventricle is moderately dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 108 ml/m2 (normal range: 65+/-11), the LVEDV is 188 ml (normal range 109+/-23), the LV end systolic volume index is 69 ml/m2 (normal range 18+/-5), the LVESV is 120 ml (normal range 31+/-10), the LV mass index is 81 g/m2 (normal range 67+/-11), and the LV mass is 140 g (normal range 114+/-24). The systolic dysfunction is global with regional variation. There is an apical inferior subendocardial late gadolinium enhancement (LGE) (60-80% thickness) and basal-mid anterolateral LGE (40-50% thickness) consistent with myocardial infarction. No left ventricular thrombus. Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 133 ml/m2 (normal range 69+/-14), the RVEDV is 231 ml (normal range 110+/-24), the RV end systolic volume index is 93 ml/m2 (normal range 22+/-8), and the RVESV is 161 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.Mitral ValveThe mitral valve is consistent with previous surgery. There is evidence of mitral regurgitation that appears valvular.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a common trunk with right innominate and left common carotid (normal variant). The aortic root is normal in size, the ascending aorta is ectatic (40 x 42 at ascending aorta, not orthogonal dimension).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated (40 mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. The coronary sinus is dilated. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is a stable right adrenal nodule and right hepatic calcified cyst (better characterized on previous cross-sectional imaging)
1. The left ventricle is moderately dilated with moderate-severely reduced systolic function (LVEF 36%). There is an apical inferior subendocardial and basal-mid anterolateral LGE consistent with myocardial infarction.2. The right ventricle is severely dilated with severely reduced systolic function (RVEF 30%)3. Severe Biatrial enlargement4. Dilated pulmonary artery5. Ectatic ascending aorta. 