44 year old woman with dyspnea, on echocardiography, there is concern for sub-aortic membrane, referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 75%, the LV end diastolic volume index is 82 ml/m2 (normal range: 65+/-11), the LVEDV is 179 ml (normal range 109+/-23), the LV end systolic volume index is 21 ml/m2 (normal range 18+/-5), the LVESV is 45 ml (normal range 31+/-10), the LV mass index is 50 g/m2 (normal range 67+/-11), and the LV mass is 109 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is hypertrophy of the basal septum, measuring 16mm at the antero-basal segment and 17mm at the infero-basal segment.No intracardiac thrombus is present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with hyperdynamic systolic function. The overall RV ejection fraction is 79%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 143 ml (normal range 110+/-24), the RV end systolic volume index is 14 ml/m2 (normal range 22+/-8), and the RVESV is 30 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve leaflets demonstrate low signal focus suggestive of calcification of the non coronary cusp. There is aortic stenosis with incomplete separation of the basal commissures of what appears to be a trileaflet but degenerative aortic valve. There is flow acceleration at the level of the aortic valve with aliasing artifact at 2 m/s. Approximately 0.5 cm below the level of the aortic valve annulus is an incomplete filamentous low signal membrane (series 1901, image 11) that arises from the basal septum (series 2001 image 5) as well as the aorto mitral skeleton. Flow acceleration is demonstrated at this level, as well.Mitral ValveThe mitral valve opens widely. There is mild systolic anterior motion of the anterior mitral leaflet. There is at least trace mitral regurgitation. Acceleration of flow is demonstrated as the anterior mitral leaflet hits the basal septum at and systole.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.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 FindingsA small hiatal hernia is present.
1. The left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 75%. No abnormal enhancement.2. The right ventricle is normal in size with hyperdynamic systolic function. The overall RV ejection fraction is 79%.3. There is outflow tract flow acceleration resulting from 3 abnormalities:Basal septal hypertrophy measuring up to 17 mm at end diastole. During systole, there is flow acceleration at the level of muscular hypertrophy.Incomplete subvalvular membrane approximately 0.5 cm below the aortic valve annulus.The configuration of the aortic valve appears to be trileaflet with incomplete separation of the basal commissures, secondary to degeneration with calcification. This results in a degree of aortic stenosis. The peak velocity at the leaflet tips is greater than 2 m/s.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.