A 42 year old female with history of repaired coarctation of Aorta and peripartum cardiomyopathy with left ventricular function that has returned to low normal. A previous cardiac MRI in 2011 showed coarctation with mild flow acceleration. A recent echocardiography showed accelerated flow at the level of the coarctation. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), the LVEDV is 131 ml (normal range 109+/-23), the LV end systolic volume index is 38 ml/m2 (normal range 18+/-5), the LVESV is 64 ml (normal range 31+/-10), the LV mass index is 42 g/m2 (normal range 67+/-11), and the LV mass is 72 g (normal range 114+/-24). There is hypokinesis of the basal inferoseptum segment only, which was described in previous echocardiography. There is a false chord in the LV apex. The left ventricle is somewhat hyper-trabeculated.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 57 ml/m2 (normal range 69+/-14), the RVEDV is 98 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 47 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. The coronary sinus is dilatedAortic ValveThe aortic valve is trileaflet, opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace 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. There is aortic coarctation originates just distal to the left subclavian artery. The aorta measures 1.3 cm at this site. There is mild-moderate flow acceleration across the coarctation. There is post-coarctation dilation of the aorta with a maximum diameter of 2.3cm. No focal aneurysms or pseudoaneurysms are noted near the coarctation site.The remaining aortic measurements are as follows:Ascending aorta: 2.6 cmAortic arch just proximal to coarctation: 1.9 cmCoarctation Site: 1.3cmDescending aorta just distal to coarctation: 2.3 cmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThere is evidence of a persistent left SVC draining into a dilated coronary sinus. The right SVC is normal in size and drain normally into the right atrium. The IVC is dilated and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease. A trivial pericardial effusion is noted. Extracardiac FindingsSternal wires were noted. A large gallstone is noted. 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 normal in size with low normal systolic function, the LVEF is 51%. There is hypokinesis of the basal inferoseptum segment only, which was described in previous echocardiography and also seen on the prior cardiac MRI. The left ventricle is also somewhat hypertrabeculated but does not meet diagnostic criteria for left ventricular non-compaction.2. The right ventricle is normal in size and systolic function, the RVEF is 52%. 3. There is evidence of a persistent left SVC draining into the coronary sinus, which is dilated.4. There is aortic coarctation originating just distal to the left subclavian artery. The aorta measures 1.3 cm at this site. There is mild to moderate flow acceleration across the coarctation. There is post-coarctation dilation of the aorta with a maximum diameter of 2.3cm. There is not aneurysm or pseudoaneurysm in the vicinity of the coarctation. Compared to the previous cardiac MRI of 2011, no significant difference was noted despite no contrast in the study performed today. 5. There is mild aortic regurgitation. The aortic valve is trileaflet.6. A gallstone is noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.