66 year old woman with history of lymphoma s/p chemotherapy and chest radiation, referred for evaluation of possible cardiac constriction. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 86 ml/m2 (normal range: 65+/-11), the LVEDV is 135 ml (normal range 109+/-23), the LV end systolic volume index is 45 ml/m2 (normal range 18+/-5), the LVESV is 70 ml (normal range 31+/-10). LV dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 48 ml/m2 (normal range 69+/-14), the RVEDV is 75 ml (normal range 110+/-24), the RV end systolic volume index is 24 ml/m2 (normal range 22+/-8), and the RVESV is 38 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is tri-leaflet. Aortic regurgitation is mild by QFlow quantification (RF 18%), on visual inspection it appears somewhat more than mild.Mitral ValveThe mitral valve is thickened with restricted leaflet opening. Mitral regurgitation is mild by Q Flow quantification (RF 19%), however visually appears mild to moderate.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.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 normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThe pericardium is minimally thickened (4mm). There is a "septal bounce" during real time free breathing imaging, most prominent during inspiration indicative of interventricular dependence. These findings may suggest presence of pericardial constriction. Extracardiac FindingsThere are liver cysts as described in other dedicated abdomen imaging. There is a large left pleural effusion and small right pleural effusion. 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. Mild LV systolic dysfunction2. Mild-moderate AR3. Mild-moderate MR4. Lower normal RV systolic function5. Minimally thickened pericardium with respirophasic IVS bounce, suggests possible constrictive physiology.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.