50 year old man with heart/kidney transplant on 10/22/15, referred for screening of cardiac allograft rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. There is borderline left ventricular hypertrophy (wall thickness10mm). The overall LV ejection fraction is 66%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 155 ml (normal range 142+/-34), the LV end systolic volume index is 22 ml/m2 (normal range 25+/-9), the LVESV is 52 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 96 g (normal range 164+/-36). 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. Qualitatively, the myocardial to skeletal T2-enhancement ratio is 1.6, which is in the normal range. The global relative enhancement is 1.68, which is in the normal range. The native myocardial T1 time in the interventricular septum is 1200 ms, which is significantly elevated and can represent edema or interstitial fibrosis. The extra-cellular volume fraction (ECV) is 37%, which is elevated. Left AtriumThe left atrium is consistent with transplant.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 62 ml/m2 (normal range 82+/-16), the RVEDV is 149 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 59 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 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsSternal wires are present. There is significant iron overload of the liver and spleen. 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. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%.2. The myocardial to skeletal T2 ratio and global relative enhancement are normal. There is no late gadolinium enhancement. These findings all speak against acute rejection. The native myocardial T1 time and the extracellular volume fraction are both elevated which could suggest rejection; however, these values would also be expected to be elevated early after heart transplantation. The earliest reported native T1 time for post-transplant myocardium was measured at 6-7 weeks and was 1100ms with a steady decline over the subsequent months. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%.4. Significant iron overload of the spleen and liver.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.