18 year old woman with LV dysfunction diagnosed post partum, referred for cardiac MRI for further evaluation of underlying etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 137 ml/m2 (normal range: 65+/-11), the LVEDV is 284 ml (normal range 109+/-23), the LV end systolic volume index is 98 ml/m2 (normal range 18+/-5), the LVESV is 203 ml (normal range 31+/-10), the LV mass index is 58 g/m2 (normal range 67+/-11), and the LV mass is 121 g (normal range 114+/-24). LV dysfunction is global. There is epicardial late gadolinium enhancement in the basal inferior wall, which is not in a typical infarct pattern and may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The region with late gadolinium enhancement also demonstrates increased native myocardial T1 times and extra-cellular volume fraction.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 64 ml/m2 (normal range 69+/-14), the RVEDV is 133 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 62 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. 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 mild to moderate 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 drain normally into the right atrium. PericardiumThere is a small to moderate sized pericardial effusion, without evidence of obvious hemodynamic compromise.Extracardiac FindingsThere are small bilateral pleural effusions. Right lower lung nodule is noted (correlation with chest CT recommended). Atelectesis/ infiltrate in left lower lung. 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 severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%.2. There is epicardial late gadolinium enhancement in the basal inferior wall, which is not in a typical infarct pattern and may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%.4. Mild to moderate tricuspid regurgitation.5. Small to moderate sized, non-hemodynamically significant pericardial effusion.6. Severe left atrial dilation.7. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.