A 17 year old male with atypical chest pain who was referred to echocardiography which showed a suspected membranous ventricular septal defect and suspected non-compaction cardiomyopathy. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The ventricle is hypertrabeculated (at the level of the papillary muscles, in the short axis plane, the non-compacted to compacted ratio is >2.3; additionally, the myocardium at the mid to apical level has a wall thickness of approximately 4mm. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 114 ml/m2 (normal range: 74+/-15), the LVEDV is 187 ml (normal range 142+/-34), the LV end systolic volume index is 58 ml/m2 (normal range 25+/-9), the LVESV is 95 ml (normal range 47+/-19), the LV mass index is 48 g/m2 (normal range 85+/-15), and the LV mass is 79 g (normal range 164+/-36). There is global mild hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracavitary thrombus.No obvious ventricular septal defect is visualized during this study. These finding support the diagnosis of left ventricular non-compaction. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is in the upper limit of normal with a low normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 114 ml/m2 (normal range 82+/-16), the RVEDV is 186 ml (normal range 142+/-31), the RV end systolic volume index is 58 ml/m2 (normal range 31+/-9), and the RVESV is 94 ml (normal range 54+/-17).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 bovine 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 are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThis 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 mildly dilated with mildly reduced systolic function, the LVEF is 49%. The ventricle is hypertrabeculated and the wall thickness is relatively thin at the mid to apical ventricular level. At the level of the papillary muscles, the diastolic non-compacted to compacted ratio is >2.3. In the appropriate setting, these findings support the diagnosis of left ventricular non-compaction. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. No left ventricular thrombus is noted. 4. No ventricular septal defect is identified on this examination. 5. The right ventricle is in the upper limit of normal with a low normal systolic function, the RVEF is 49%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.