81-year-old female with history of paroxysmal atrial fibrillation.CPT: 75572 Left Atrium: The left atrium is severely dilated. The left atrial volume minus the pulmonary veins is 150 ml. There is early branching of the right superior and inferior pulmonary vein. There is additionally a small right-sided vertical vein. The left sided pulmonary veins have a common ostium but branch early. A small atrial septal defect is noted (3-4mm). There is a filling defect in the left atrial appendage which could represent either poor flow or a thrombus. RSPV: 18 x 16 mmRIPV: 12 x 11 mmRight Vertical Vein: 6x7mmLSPV: 23 x 19 mmLIPV: 19 x 9 mmRight atrium, vena cavae, and coronary sinus: The right atrium is severely dilated. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Left Ventricle: The left ventricular end-systolic volume is dilated (LV volume 110ml).Coronary arteries: Because heart rate management was not attempted and nitroglycerine was not administered, this exam was not performed to optimally visualize the coronary arteries. However within the limitations of the study the following observations are made:LM: The left main coronary artery arises normally from the left sinus of valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is moderate to severe calcification of the proximal and mid LAD. LCx: The left circumflex coronary artery courses normally in the the left AV groove. It gives rise to the obtuse marginal branches and a small AV circumflex branch.RCA: The right coronary artery arises normally from the right sinus of valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There is mild calcification of the RCA. Great vessels: The visualized portions of the aorta demonstrate no evidence of dissection or aneurysm. The aortic root is within normal limits. The aortic arch is not imaged. Mild atherosclerosis of descending aorta. The main pulmonary artery is mildly dilated. Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.
1.Severe biatrial dilation with alternate pulmonary vein anatomy as described above.  2. Filling defect in left atrial appendage, which could represent either thrombus or poor flow. Correlation with TEE suggested. 3. Small atrial septal defect with evidence of left to right shunting.  4. Mild dilation of main pulmonary artery. 5. Mild thickening of mitral leaflets.  6. Coronary and aortic atherosclerosis noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.