Worsening cardiac function, evaluate for infiltrative disease. Left VentricleThe left ventricle is dilated with globally decreased function. The overall LV ejection fraction is 21%, the LV end diastolic volume index is 170 ml/m2 (normal range: 74+/-15), the LVEDV is 358 ml (normal range 142+/-34), the LV end systolic volume index is 135 ml/m2 (normal range 25+/-9), the LVESV is 283 ml (normal range 47+/-19), the LV mass index is 89 g/m2 (normal range 85+/-15), and the LV mass is 186 g (normal range 164+/-36). . There is noted late gadolinium enhancement in the basal and mid inferior portion of the myocardium to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is not calculated in setting of underlying arrhythmia. There is [ no ]myocardial iron overload. There is [no noted ]LV thrombus. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is borderline dilated. The overall RV ejection fraction is 15%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 195 ml (normal range 142+/-31), the RV end systolic volume index is 79 ml/m2 (normal range 31+/-9), and the RVESV is 166 ml (normal range 54+/-17).Right AtriumThe right atrium is dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate 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 with no noted pulmonary vein stenosis.Pulmonary 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 FindingsPatchy pulmonary findings, right lung greater than left, which may be consistent with resolving pulmonary edema vs pneumonia/infection/pulmonary hemorrhage - clinical correlation recommended. 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. Severely decreased LV EF with global LV dysfunction. There is a focus of delayed gadolinium hyperenhancement in the basal to mid inferoseptal portion of the left ventricle which may represent right-sided volume or pressure overload. Localized scar, inflammation, or an infiltrative process is less likely.2. Decreased RV function. 3. Severely dilated left atrium and dilated right atrium.4. Moderate mitral regurgitation5. Pulmonary findings as above. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.