38 year old woman with history of right sided heart failure and nephrotic syndrome, with new biventricular dysfunction and hypertrophy on echocardiogram; now referred for cardiac MRI to evaluate for possible infiltrative disease. Left VentricleThe left ventricle is upper normal in size with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 87 ml/m2 (normal range: 65+/-11), the LVEDV is 148 ml (normal range 109+/-23), the LV end systolic volume index is 59 ml/m2 (normal range 18+/-5), the LVESV is 99 ml (normal range 31+/-10). LVH is present. LV wall motion is globally reduced. There is no delayed enhancement to suggest an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of myocardial iron overload. Left AtriumThe left atrium is dilated. Right VentricleThe right ventricle is moderate-severely dilated with reduced systolic function . The overall RV ejection fraction is 28%, the RV end diastolic volume index is 122 ml/m2 (normal range 69+/-14), the RVEDV is 205 ml (normal range 110+/-24), the RV end systolic volume index is 87 ml/m2 (normal range 22+/-8), and the RVESV is 147 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated . Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely with at least mild mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated (33mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsThere are bilateral pleural effusions, right greater than left. There is an area of consolidation in the right lower lobe. 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. Upper normal sized left ventricle with global moderately reduced systolic function (EF 33%)2. Moderate-severely dilated right ventricle with severely reduced function (EF 28%). 3. Biatrial dilatation4. At least moderate tricuspid regurgitation 5. Bilateral pleural effusions. 6. Dilated main pulmonary artery I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.