47 year old man with history of congenital heart block s/p pacemaker and pes excavatum s/p surgery, now with worsening LV EF and referred for cardiac MRI to assess function. Left VentricleThe left ventricle is moderately dilated with moderately reduced function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 119 ml/m2 (normal range: 74+/-15), the LVEDV is 246 ml (normal range 142+/-34), the LV end systolic volume index is 76 ml/m2 (normal range 25+/-9), the LVESV is 157 ml (normal range 47+/-19). LV mass index is 58g/m2, and LV mass is 120g. As seen on the previous MRI, there is a muscular band at the LV apex which alters the apical contours and causes apical dyskinesis. The apex is aneurysmal; however, it is not well seen due to artifact and the finding could potentially represent a diverticulum or also be a extreme normal variant. Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 99ml/m2 (normal range 82+/-16), the RVEDV is 205 ml (normal range 142+/-31), the RV end systolic volume index is 52 ml/m2 (normal range 31+/-9), and the RVESV is 107 ml (normal range 54+/-17). There is a pacemaker lead in the right ventricle. Right AtriumThe right atrium is mildly dilated. There is a pacemaker lead in the right atrium.Aortic ValveThe aortic valve opens widely and there is at least mild regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is grossly normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a pacemaker in the left chest wall with associated artifact. 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. Moderately dilated left ventricle with moderate reduced systolic function (EF 36%). This has worsened since the previous MRI of 10/2013. The apex is not well seen due to severe artifact from the pacemaker can (see above for details).2. Normal sized RV with normal systolic function (EF 48%). 3. Dual chamber pacemaker with significant associated artifact. 4. At least mild aortic regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.