75 year old male with history of aortic valve disease and coronary artery disease with aortic valve replacement and 3 vessel coronary artery bypass grafting in 2004 with known dilated thoracic aorta presenting for evaluation of aortic dilation and cardiac function. Left VentricleThe left ventricle is normal in size and with low normal systolic function and mild to moderate left ventricular hypertrophy. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 135 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 62 ml (normal range 47+/-19), the LV mass index is 56 g/m2 (normal range 85+/-15), and the LV mass is 108 g (normal range 164+/-36). There is basal inferior hypokinesis. Septal wall dyssynergy likely consistent with previous surgery. There are areas of subendocardial late gadolinium enhancement in the basal inferior and basal lateral wall consistent with previous myocardial infarction. These areas were noted on the previous study in 01/2015.Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVEDV is 125 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 62 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve has been replaced with a bioprosthetic valve. There is no significant aortic regurgitation. 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 dilated (see measurements below). There is mild aortic tortuosity in the descending thoracic aorta without significant dilation. Ascending aorta (largest portion): 44 x 40 mmAscending aorta (just proximal to right innominate): 37 x 35 mmAorta (mid arch): 29 mmDescending Thoracic Aorta: 26 mmPulmonary 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 FindingsThe right hemidiaphragm is elevated. Sternotomy wires are present. 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. The left ventricle is normal in size and with low normal systolic function and mild to moderate left ventricular hypertrophy. The overall LV ejection fraction is 54%2. There are areas of subendocardial late gadolinium enhancement in the basal inferior and basal lateral wall consistent with previous myocardial infarction. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%4. Dilated ascending aorta. See above for specific measurements.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.