A 60 year old female with syncope and abnormal electrocardiogram (giant negative T-wave) and suspected apical hypertrophy by echocardiogram. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size with systolic hyperdynamic performance. Mild apical cavity obliteration was noted. The overall LV ejection fraction is 75%, the LV end diastolic volume index is 52 ml/m2 (normal range: 65+/-11), the LVEDV is 83 ml (normal range 109+/-23), the LV end systolic volume index is 13 ml/m2 (normal range 18+/-5), the LVESV is 20 ml (normal range 31+/-10), the LV mass index is 67 g/m2 (normal range 67+/-11), and the LV mass is 107 g (normal range 114+/-24). There are no regional wall motion abnormalities present. The basal septum is thickened at 15mm at end diastole. The apical anterior wall is 12mm. No late gadolinium enhancement. While this is not typical case of hypertrophic cardiomyopathy, some cases may not demonstrate late gadolinium enhancement.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 66%, the RV end diastolic volume index is 54 ml/m2 (normal range 69+/-14), the RVEDV is 86 ml (normal range 110+/-24), the RV end systolic volume index is 18 ml/m2 (normal range 22+/-8), and the RVESV is 29 ml (normal range 35+/-13). The RV free wall has normal thickness.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 mild mitral regurgitation. Systolic anterior movement (SAM) of the mitral valve causes accelerated flow forward in the subvalvular outflow tract. 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 branching pattern. The aorta 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 are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is a right lateral thoracic meningocele.
1. The left ventricle is normal in size with systolic hyperdynamic performance, the LVEF is 75%. LV mass is normal. Mild apical cavity obliteration with basal septal hypertrophy causing SAM. No enhancement. While this is not a typical case of hypertrophic cardiomyopathy, the constellation of findings do raise the question of LV HCM. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 66%. The RV free wall demonstrates normal thickness.4. The aortic valve opens widely and there is no significant aortic regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.