A 28 year old female with personal history of mild asthma recently with dyspnea and atypical chest pain during exercise. Prior MRI 4/2016 with findings of low normal left and right ventricular function and severe biventricular dilation. Etiology unclear, possible Etoh. Recommendations made for Etoh cessation and repeat MRI. Left VentricleThe left ventricle is severely dilated with low normal systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 98 ml/m2 (normal range: 65+/-11), the LVEDV is 165 ml (normal range 109+/-23), the LV end systolic volume index is 49 ml/m2 (normal range 18+/-5), the LVESV is 83 ml (normal range 31+/-10), the LV mass index is 52 g/m2 (normal range 67+/-11), and the LV mass is 87 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is normal wall thickness. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1-time 924 which is within normal limits. These findings suggest the absence of an underlying infiltrative, inflammatory, or fibrosis process in the myocardium.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is severely dilated with low normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 98 ml/m2 (normal range 69+/-14), the RVEDV is 165 ml (normal range 110+/-24), the RV end systolic volume index is 49 ml/m2 (normal range 22+/-8), and the RVESV is 115 ml (normal range 35+/-13). The heart is shifted into the left thorax as a consequence of the decreased sternum to spine dimension. The sternum is extrinsically compressing on the RV free wall, distorting its shape and causing variation in the regional motion. However, there is no evidence that this extrinsic compression is hemodynamically significant. Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and 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 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 drain normally into the right atrium. IVC is grossly normal. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is significant scoliosis and decreased space between the sternum and spine without evidence of a classical pectus deformity. 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 again dilated with low normal systolic function, the LVEF is 50% without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. The right ventricle is also again dilated with low normal systolic function, the RVEF is 50%. 3. Significant changes of scoliosis are noted as per prior MRI. Although there is no classical pectus deformity of the sternum, the anterior-to-posterior dimension between the sternum and spine is as small as 4.5cm. The reduced space has caused the heart to be shifted into the left thorax and distorted the shape of the right ventricle. This extrinsic compression of the right ventricle does not appear to be causing any hemodynamically significant changes. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.