55 year-old man with paroxysmal atrial fibrillation. Previously aborted/failed ablation. Referred for cardiac CMR. There is a history of absence of the left upper lobe of the lung. This has resulted in rotation and displacement of the heart towards the left lower mediastinum. This displacement made it difficult to obtain the standard imaging planes for volume, ejection fraction and late gadolinium enhancement evaluation, limiting overall assessment. This is a technically challenging examination. Left VentricleThe left ventricle appears to be of normal size with low normal systolic function. The overall LV ejection fraction is ~50%, the LV end diastolic volume index is 81 ml/m2 (normal range: 74+/-15), the LVEDV is 180 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 87 ml (normal range 47+/-19). There are no obvious regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is compressed on the views provided. Assessment is complicated by positioning of the heart.Right VentricleThe right ventricle is of normal size with mildly reduced systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 216 ml (normal range 142+/-31), the RV end systolic volume index is 56 ml/m2 (normal range 31+/-9), and the RVESV is 126 ml (normal range 54+/-17).Right AtriumThe right atrium appears enlarged on axial views. The assessment is complicated by the positioning of the heart.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 is not well seen.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic sinus of valsalva measures 45 x 45 x 42 mm. The sinotubular junction measures 40 x 39 mmThe ascending aorta measures 36 x 37 mm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Left upper pulmonary vein measures = 20 x 14 mmLeft lower pulmonary vein measures = 27 x 15 mmRight upper pulmonary vein measures = 16 x 15 mmRight lower pulmonary vein measures = 17 x 17 mmPulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumPortions of the pericardial sac can be seen on the post contrast e-thrives. However, on dynamic cine images a pericardial silhouette is not seen. Cannot rule out congenital absence or partial absence of the pericardial sac.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. Technically challenging examination. History of absence of the left upper lobe of the lung resulting in significant rotation and displacement of the heart towards the left lower mediastinum making it difficult to obtain the standard imaging planes for volume, ejection fraction and late gadolinium enhancement assessment. 2. The left ventricle appears to be of normal size with low normal systolic function. The overall LV ejection fraction is ~50%. No late gadolinium enhancement.3. The right ventricle is of normal size with mildly reduced systolic function. Calculated RV ejection fraction is 42%4. Only small portions of the pericardial sac can be seen. On dynamic cine images a pericardial silhouette is not seen. Cannot rule out congenital absence or partial absence of the pericardial sac.5. See above measurement for pulmonary veins and aorta.