66 year old male with history of rheumatic heart disease, diabetes, hypertension who presents for cardiac MRI to further evaluate aortic valve regurgitation, aortic valve stenosis, and ascending aorta. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 92 ml/m2 (normal range: 74+/-15), the LVEDV is 192 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 63 g/m2 (normal range 85+/-15), and the LV mass is 131 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is late gadolinium enhancement in the basal inferolateral wall which spares the endocardium and is in a pattern atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process, such as old myocarditis/ vasculitis/ etc.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 159 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly increased.Aortic ValveThere is a bioprosthetic valve is the aortic position. There is mild aortic regurgitation. There is thickening and likely calcification of the aortic valve; however, aortic valve morphology is limited by artifact caused by the prosthetic valve. There is evidence of flow acceleration through the aortic valve and aliasing at a velocity of 3m/s. These findings suggest that there is at least moderate aortic valve stenosis, with a peak velocity >3m/s.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. The aortic root is normal in size; however, the ascending aorta is mildly dilated (43mm) measured approximately 5cm from the aortic valve plane.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 obvious pericardial disease.Extracardiac FindingsSternal wires are noted. 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. Normal LV size and systolic function (LVEF 58%) with evidence of late gadolinium enhancement involving the basal inferolateral wall. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. The finding most likely represents prior myocarditis.2. Normal RV size and systolic function (RVEF 60%).3. Severe left atrial dilation.4. There is a bioprosthetic valve is the aortic position. There is thickening of the aortic valve with at least moderate aortic valve stenosis and mild aortic regurgitation.5. Mild dilation of the ascending aorta. 