34 year old man with history of dilated cardiomyopathy s/p orthotopic heart transplant in 2007, admitted with exertional dyspnea and now referred for cardiac MRI to evaluate for graft function and possible rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 168 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 66 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 96 g (normal range 164+/-36). Wall thickness is normal (9mm in the anteroseptum and inferolateral wall). There are no regional wall motion abnormalities present. T2-STIR myocardium:skeletal ratio is borderline elevated (2). There is subtle patchy late gadolinium enhancement in the basal inferolateral wall in a pattern which is atypical for myocardial infarction, and suggests possible underlying infiltrative, inflammatory or fibrotic changes of the myocardium.The native T1 myocardial relaxation time is normal at 980-1030ms. There is no LV thrombus. Left AtriumThe left atrium is enlarged, consistent with previous cardiac transplant. Right VentricleThe right ventricle is normal in size for body surface area, but qualitatively it appears somewhat enlarged. Normal RV systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 208 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 99 ml (normal range 54+/-17).Right AtriumThe right atrium is enlarged, consistent with previous cardiac transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a pseudo-bovine 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 mildly dilated.Venous AnatomyThe SVC and IVC drain normally into the right atrium. The IVC appears dilated.PericardiumThere is no pericardial effusion.Extracardiac FindingsSternotomy wires are present. 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 normal systolic function (LVEF 60%). While the native T1 myocardial relaxation time is normal, there is subtle increase in myocardial T2 ratio and mild late gadolinium enhancement in the basal and mid inferolateral wall in a pattern atypical for myocardial infarction, which suggests underlying myocardial fibrosis, inflammation or infiltration.2. Normal size right ventricle with normal systolic function (RVEF 52%).3. Mildly dilated main pulmonary artery.4. Moderate mitral regurgitation. 5. Mild to moderate tricuspid regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.