66 year old female with history of non-ischemic cardiomyopathy, severe MR referred for pre-transplant evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 152 ml/m2 (normal range: 65+/-11), the LVEDV is 264 ml (normal range 109+/-23), the LV end systolic volume index is 126 ml/m2 (normal range 18+/-5), the LVESV is 218 ml (normal range 31+/-10), the LV mass index is 70 g/m2 (normal range 67+/-11), and the LV mass is 122 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is a midmyocardial stripe in the septum and basal to mid inferior wall which is atypical for myocardial infarction, and is consistent with dilated cardiomyopathy.The native T1 myocardial relaxation time is 1240ms, which is elevated and suggests a diffuse myocardial fibrotic or infiltrative process. There is no LV thrombus visualized on this study. There is no evidence for myocardial iron overload.Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 21%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 155 ml (normal range 110+/-24), the RV end systolic volume index is 70 ml/m2 (normal range 22+/-8), and the RVESV is 122 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is trivial aortic regurgitation.Mitral ValveThe mitral valve demonstrates bileaflet tethering, and there is at least mild moderate 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 a trivial pericardial effusion.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. The left ventricle is severely dilated with severely reduced systolic function (EF 17%). There is global hypokinesis with regional variation. 2. There is a midmyocardial stripe in the septum and basal inferior wall, which is atypical for infarction and suggests a nonischemic etiology of this patient's cardiomyopathy. Additionally, the native T1 myocardial relaxation time is moderately elevated at 1240ms, which also suggests an underlying diffuse myocardial fibrotic or infiltrative process.3. No left ventricular thrombus was visualized. 4. The right ventricle is normal in size with severely reduced systolic function (EF 21%). 5. Bileaflet tethering of the mitral valve with at least mild-moderate mitral regurgitation. 6. Biatrial dilation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.