A 48 year old male with recurrent atrial fibrillation after 2 pulmonary veins isolation procedures. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 172 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 76 ml (normal range 47+/-19), the LV mass index is 49 g/m2 (normal range 85+/-15), and the LV mass is 95 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is late gadolinium enhancement at base of the inferolateral and inferior segments. The pattern spears the endocardium and is not consistent with myocardial infarction. These findings are suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, such as old myocarditis. Left AtriumThe left atrium is moderately dilated (138ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 102 ml/m2 (normal range 82+/-16), the RVEDV is 198 ml (normal range 142+/-31), the RV end systolic volume index is 49 ml/m2 (normal range 31+/-9), and the RVESV is 97 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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. No pulmonary vein stenosis was noted. The pulmonary vein ostia measurements are below. Based on late gadolinium enhancement imaging, right superior and right inferior pulmonary veins are well isolated with circumferential LGE. There appears to be a large ablation gap (i.e. no LGE) along the superior margin of the left superior pulmonary vein and also along the superior and posterior margin of the left inferior pulmonary vein.Left upper pulmonary vein: 20x17mmLeft inferior pulmonary vein: 20x13mmRight upper pulmonary vein: 24x19mmRight inferior pulmonary vein: 24x22mmPulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.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 normal in size with normal systolic function, the LVEF is 56%. 2. There is late gadolinium enhancement at base of the inferolateral and inferior segments. These findings are suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, such as old myocarditis. The pattern spears the endocardium and is not consistent with myocardial infarction.3. The right ventricle is normal in size with normal systolic function, the RVEF is 51%. 4. The left atrium is moderately dilated and the right atrium is mildly dilated.5. There is mild mitral regurgitation.6. All four pulmonary veins drain normally into the left atrium. No stenosis was noted.7. Based on late gadolinium enhancement imaging, right superior and right inferior pulmonary veins are well isolated with circumferential LGE around the ostia. There appears to be a large ablation gap (i.e. no LGE) along the superior margin of the left superior pulmonary vein and also along the superior and posterior margin of the left inferior pulmonary vein.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.