54-year-old male with history of aortic valve replacement (bioprosthetic) for severe aortic regurgitation and a ventricular septal defect with chest pain, syncope, dizziness, diaphoresis. Minimal paravalvular leak on TEE. Referred for cardiac MRI to evaluate for questionable dehiscence. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 49%. The LVEDV is 173 ml (normal range 142+/-34), the LV end diastolic volume index is 103 ml/m2 (normal range: 74+/-15), the LVESV is 89 ml (normal range 47+/-19) and the LV end systolic volume index is 53 ml/m2 (normal range 25+/-9). The LV mass is 109 g (normal range 164+/-36) and the LV mass index is 65 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is small amount of late gadolinium enhancement in the basal anteroseptal wall possibly due to previous VSD repair.The native T1 myocardial relaxation time is 1110 ms in the ventricular septum and 1147 in the LV free wall.There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%. The RVEDV is 133 ml (normal range 142+/-31), RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVESV is 62 ml (normal range 54+/-17), and the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe bioprosthetic aortic valve opens opens widely. There is no significant aortic regurgitation. No paravalvular leak is noted.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 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.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsScattered subcentimeter pulmonary nodules and mild mediastinal and hilar lymphadenopathy. Correlation with chest CT is 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.
No convincing evidence of aortic perivalvular leak or aortic valvular dysfunction.1.The left ventricle is normal in size with mildly reduced systolic function. LVEF 49%. 2.Small amount of late gadolinium enhancement in the basal anteroseptal wall possibly due to previous VSD repair.3.The right ventricle is normal in size with normal systolic function. RVEF 53%.4.Normally functioning bioprosthetic aortic valve with no regurgitation and no paravalvular leak.5.Scattered subcentimeter pulmonary nodules and mild mediastinal and hilar lymphadenopathy. Correlation with chest CT is suggested. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.