64 year old woman with history of severe pulmonary hypertension and systemic hypertension referred for non-contrast MRI to assist with RV assessment. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 53 ml/m2 (normal range: 65+/-11), the LVEDV is 96 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 40 ml (normal range 31+/-10). There is systolic flattening of the interventricular septum which suggests RV pressure overload.Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is severely dilated with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 205 ml/m2 (normal range 69+/-14), the RVEDV is 372 ml (normal range 110+/-24), the RV end systolic volume index is 106 ml/m2 (normal range 22+/-8), and the RVESV is 192 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. The coronary sinus is dilated.Aortic ValveThe aortic valve opens widely and there is trivial aortic regurgitation (regurgitant fraction of 4%).Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trivial pulmonic regurgitation regurgitant fraction of 2%).Tricuspid ValveThe tricuspid valve opens widely. There is severe tricuspid regurgitation. 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 severely dilated (39mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.ShuntsThere is apparent left to right flow across the interatrial septum which suggests the presence of an interatrial septal defect. Qp:Qs is 2.4, supportive of significant L to R shunt. (Pulmonic flow 8.4L/min; Systemic flow 3.7L/min).PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsDilated hepatic veins. 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 size LV with normal systolic function (EF 59%). Interventricular septal flattening in systole which suggests RV pressure overload.2. Severe RV dilation with mildly reduced systolic function (EF 48%).3. Evidence of interatrial septal defect with Qp:Qs of 2.4 indicating significant L to R shunting. 4. Severe biatrial dilation. 5. Severe tricuspid regurgitation.6. Mild mitral regurgitation.7. Severely dilated main pulmonary artery.