59 year old woman with history of hypertrophic cardiomyopathy, atrial fibrillation s/p MAZE and LA appendage thrombectomy, admitted with heart failure and referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 60 ml/m2 (normal range: 65+/-11), the LVEDV is 130 ml (normal range 109+/-23), the LV end systolic volume index is 29 ml/m2 (normal range 18+/-5), the LVESV is 63 ml (normal range 31+/-10).There is asymmetric hypertrophy of the septum, predominantly in the inferoseptum (maximal thickness measures 15mm). There is basal inferoseptal and inferior hypokinesis with an aneurysmal shape. There is additionally a small region of dyskinesis in the apical septal wall. Late gadolinium enhancement images were technically limited; however, there is only a small amount of transmural late gadolinium enhancement involving the apical septal wall. The overall burden of late gadolinium enhancement is small.Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 40%. The RV dysfunction is worst in the right ventricular outflow tract. The RV end diastolic volume index is 60 ml/m2 (normal range 69+/-14), the RVEDV is 129 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 78 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.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 drain normally into the right atrium. PericardiumThere is borderline thickening of the pericardium.Extracardiac FindingsThere is a small right pleural effusion. There are dilated intrahepatic 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 left ventricle with evidence of asymmetric hypertrophy of the basal inferoseptum (maximum wall thickness is 15mm). LV function is mildly reduced (EF 51%). The basal inferior wall is hypokinetic with an aneurysmal shape. The apical septum is dyskinetic.2. There is a small amount of late gadolinium enhancement in the apical septal wall.3. The right ventricle is normal in size with mild-moderately reduced systolic function (EF = 40%).4. Severe biatrial dilation. 5. The pericardium is borderline thickened.6. Small right pleural effusion with dilated intra-hepatic veins. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.