60 year old male with persistent atrial fibrillation after ablation. Referred for cardiac MRI prior to redo PVI and to assess pulmonary vein anatomy and LVEF. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%. The LVEDV is 139 ml (normal range 142+/-34), the LV end diastolic volume index is 67 ml/m2 (normal range: 74+/-15), the LVESV is 73 ml (normal range 47+/-19) and the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9). The LV mass is 72 g (normal range 164+/-36) and the LV mass index is 35 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is <1000 ms (normal), suggestive of absence of underlying diffuse fibrosis or infiltration.There is no myocardial iron overload. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly depressed systolic function. The overall RV ejection fraction is 48%. The RVEDV is 161 ml (normal range 142+/-31), RV end diastolic volume index is 77 ml/m2 (normal range 82+/-16), the RVESV is 84 ml (normal range 54+/-17), and the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThere 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 descending thoracic aorta is severely tortuous.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. The right middle lobe pulmonary vein drains independently into the left atrium, just anterior to the right lower pulmonary vein ostium. There is no apparent pulmonary vein stenosis.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC 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.Normal sized LV with mildly depressed systolic function (LVEF 48%).2.Normal sized RV with mildly depressed systolic function (RVEF 48%).3.No pulmonary vein stenosis. The right middle lobe pulmonary vein drains independently into the left atrium just adjacent to the right lower pulmonary vein ostium. 4.The left ventricular myocardium is completely viable.5.Mild biatrial dilation.