A 48 year old male with pericarditis on 2013 who developed constrictive pericarditis diagnosed by echocardiography, right heart cath and cardiac MRI (10/15/2014), referred to cardiac MRI as a follow up to decide about surgery. Left VentricleThe left ventricle is normal size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 169 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 77 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There is abnormal interventricular septal motion. With realtime imaging, the abnormal septal motion / flattening is clearly more prominent in inspiration. There is no myocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. There is an interatrial septum aneurysm noted. 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 97 ml/m2 (normal range 82+/-16), the RVEDV is 173 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 84 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 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.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC normally into the right atrium. The IVC is very dilated consistent with elevated RA pressure. Dilated coronary sinus consistent with elevated RA pressure.PericardiumThere is no pericardial effusion. There is diffuse circumferential pericardial thickening (4-6mm) with mild late gadolinium enhancement. Thickening is most prominent over the RV and RA.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 size and systolic function, the LVEF is 55%. There are no regional wall motion abnormalities present. 2. There is no myocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 51%. 4. There is diffuse circumferential pericardial thickening (4-6mm) with mild late gadolinium enhancement. There are signs of interventricular dependence which varies with respiratory cycle. Several markers of significant elevation of RA pressure. Taken in combination these findings suggest pericardial constriction which is hemodynamically significant.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.