80 year old man with history of coronary disease, history of melanoma with left lung recurrence s/p resection in February 2016, and persistent atrial fibrillation, now referred for pre-ablation cardiac MRI to delineate atrial volumes and pulmonary vein dimensions. Left VentricleThe left ventricle is normal in size with mild-moderately reduced systolic function. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 177 ml (normal range 142+/-34), the LV end systolic volume index is 52 ml/m2 (normal range 25+/-9), the LVESV is 104 ml (normal range 47+/-19), the LV mass index is 53 g/m2 (normal range 85+/-15), and the LV mass is 105 g (normal range 164+/-36). There is global hypokinesis . There is subtle patchy late gadolinium enhancement in the basal inferior, inferolateral and lateral wall which is atypical for prior myocardial infarction and may represent an underlying inflammatory, infiltrative or fibrotic process. In addition there appears to be basal inferolateral mid-myocardial late gadolinium enhancement also diffuse and possibly representative of underlying inflammatory, infiltrative or fibrotic process. Native T1 myocardial relaxation time is elevated (1170-1243ms) which is abnormal. Left AtriumThe left atrium is severely dilated, with a maximal volume of 163mL. The interatrial septum is intact. There is no evidence for left atrial appendage thrombus.Right VentricleThe right ventricle is normal in size with mild-moderately reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 107 ml/m2 (normal range 82+/-16), the RVEDV is 214 ml (normal range 142+/-31), the RV end systolic volume index is 64 ml/m2 (normal range 31+/-9), and the RVESV is 128 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated with a maximal volume of 215mL.Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is at least mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild-moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The ascending aorta is upper normal in size (41mm x 39mm)Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. The individual pulmonary vein dimensions are as listed below:LUPV: 17 x 15mmLLPV: 17 x 14mmRUPV: 17 x 16mmRLPV: 19 x 18mmPulmonary ArteryThe main pulmonary artery is mild to moderately dilated (36mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsExtensive post surgical changes and fluid collection in the left lung consistent with patient's recent pulmonary resection. There is a trivial right pleural effusion. 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 left ventricle with mild-moderately reduced systolic function (LVEF 41%).2. Abnormal native T1 myocardial relaxation time with patchy subtle late gadolinium enhancement in the basal segments of the left ventricle; taken together, a possible infiltrative, inflammatory or fibrotic underlying process should be considered.3. Normal size right ventricle with mild-moderately reduced systolic function (RVEF 40%). 4. Biatrial enlargement. 5. Moderately dilated main pulmonary artery. 6. Post surgical changes of the left lung with associated volume loss and fluid collection, consistent with history of recent lung resection. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.