74 year old male with a history of bicuspid aortic valve s/p bioprosthetic aortic valve replacement, aortic aneurysm. Referred for cardiovascular MRI to evaluate function and aneurysm dimensions. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 59 ml/m2 (normal range: 74+/-15), the LVEDV is 111 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 50 ml (normal range 47+/-19), the LV mass index is 66 g/m2 (normal range 85+/-15), and the LV mass is 124 g (normal range 164+/-36). There are no regional wall motion abnormalities present. A sigmoid septum is noted. The IVSd=13mm and PWd=9mm. There is a small amount of transmural late gadolinium enhancement (most likely in a myocardial infarction pattern) involving the basal inferolateral and basal inferoseptal walls. These segments are unlikely to be viable; however, the remainder of the myocardium is free of late gadolinium enhancement and is viable. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 58 ml/m2 (normal range 82+/-16), the RVEDV is 109 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 52 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThere is artifact from a bioprosthetic aortic valve obscuring the details of the aortic valve anatomy. Phase contrast imaging demonstrated no significant stenosis or insufficiency.Mitral ValveThe mitral valve opens widely and there is mild 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. Aortic root and ascending aorta are mildly dilated. No aortic coarctation is noted. The measurements are:Sinus of Valsalva: 42mm x 41mm x 39mmSinotubular Junction: 34x33mmAscending Aorta (6cm from AV valve): 43x42mmProximal descending aorta is 32x30mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is somewhat small in caliber (20mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires and coronary bypass markers are noted. The right hemi-diaphragm is elevated. 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. Mild aortic root dilation, as detailed above.2. Normal LV size and systolic function (LVEF 55%) with evidence of small myocardial infarction involving the basal inferolateral and inferoseptal walls.3. Normal RV size and systolic function (RVEF 52%).4. Bioprosthetic valve noted in aortic position.5. Small caliber of main pulmonary artery. 6. Elevated right hemi-diaphragm noted.