71 year old male with a history of ventricular tachycardia s/p EP ablation resulting in perforation of LV free wall. Referred for cardiovascular MRI to evaluate for underlying infiltrative or inflammatory disease. Left VentricleThe left ventricle is normal in size and systolic function. There is abnormal septal motion which may be the result of sternotomy. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 130 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 75 ml (normal range 47+/-19), the LV mass index is 61 g/m2 (normal range 85+/-15), and the LV mass is 123 g (normal range 164+/-36). There is a small focal region of late gadolinium enhancement in the mid lateral wall, which suggests the presence of a focal underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 125 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 60 ml (normal range 54+/-17).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 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 mild 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 minimal pericardial effusion. There is mild late gadolinium enhancement of the pericardium.Extracardiac FindingsAir seen in the proximal esophagus. Sternotomy. 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. Normal left ventricular size and systolic function (LVEF 57%). There is a small focal region of late gadolinium enhancement in the mid lateral wall, which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. Normal right ventricular size and systolic function (RVEF 52%).3. Minimal pericardial effusion, and late gadolinium enhancement of the pericardium. 4. See extracardiac findings.