A 78 year old male with diabetes mellitus, hypertension, hyperlipidemia and a systolic murmur found to be secondary to aortic insufficiency by echo which showed an eccentric jet. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is mildly dilated with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 115 ml/m2 (normal range: 74+/-15), the LVEDV is 259 ml (normal range 142+/-34), the LV end systolic volume index is 54 ml/m2 (normal range 25+/-9), the LVESV is 122 ml (normal range 47+/-19), the LV mass index is 72 g/m2 (normal range 85+/-15), and the LV mass is 162 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There are two regions of late gadolinium enhancement. The first is an atypical pattern of late gadolinium enhancement which spares the endocardium and involves the basal inferolateral wall. The second is a mid-wall stripe pattern involving the basal septum. Both of these patterns are atypical for prior myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Together this pattern has previously been described as a pattern of prior myocarditis.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 110 ml/m2 (normal range 82+/-16), the RVEDV is 247 ml (normal range 142+/-31), the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9), and the RVESV is 103 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet and opens widely. There is moderate aortic regurgitation with regurgitant volume of 39ml and regurgitant fraction of 28%.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 ascending aorta is upper limits of normal without evidence of aneurysm or dissection. The measurements are:Sinus of Valsalva: 33x33x36mmSinotubular Junction: 31mmAscending Aorta: 39x39mmPulmonary 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 obvious pericardial disease.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. Mild left ventricular dilation with low normal systolic function (LVEF 53%).2. There are two regions of late gadolinium enhancement. The first is an atypical pattern of late gadolinium enhancement which spares the endocardium and involves the basal inferolateral wall. The second is a mid-wall stripe pattern involving the basal septum. Both of these patterns are atypical for prior myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Together this pattern has previously been described as a pattern of prior myocarditis.3. Normal right ventricular size and systolic function (RVEF 58%).4. Trileaflet aortic valve with moderate, central aortic regurgitation.5. No thoracic aortic aneurysm or dissection. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.