67 year old woman with history of CABG, Type A dissection s/p repair, permanent pacemaker placement for significant pauses, now s/p VT ablation. Referred for cardiac MRI to evaluate RV size/function and presence of scar. The patient has a permanent pacemaker, but is not pacemaker dependent. EP was present to reprogram the device pre and post study. Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 111 ml/m2 (normal range: 65+/-11), the LVEDV is 213 ml (normal range 109+/-23), the LV end systolic volume index is 56 ml/m2 (normal range 18+/-5), the LVESV is 107 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 84 g (normal range 114+/-24). Basal to mid inferior hypokinesis and thinning. There is late gadolinium enhancement extending from the basal to mid inferior walls, suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is patchy, however there a portions which appear to involve the sub-endocardium. The significance of this pattern is unclear, but could be explained by prior coronary disease.Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 33%, the RV end diastolic volume index is 193 ml/m2 (normal range 69+/-14), the RVEDV is 369 ml (normal range 110+/-24), the RV end systolic volume index is 130 ml/m2 (normal range 22+/-8), and the RVESV is 248 ml (normal range 35+/-13). Of note, there is significant artifact present due to the patient's RV pacemaker lead. Right AtriumThe right atrium is severely dilated. Mitral ValveThe mitral valve opens widely with mild-moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is severe tricuspid regurgitation.Aorta/Aortic ValveThere is a left sided aortic arch with a normal brachiocephalic branching pattern. There is a graft extending from the ascending aorta to the mid arch consistent with patient prior surgery for type A dissection. The native aortic valve was re-suspended. There is trace AI. The aortic root at the sinus of valsalva measures 41mm. The ascending aorta measures 45mm (graft). There is atherosclerosis of the descending thoracic aorta.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated, measuring 34mm.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. There is a pacemaker lead noted in the SVC and RA.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal 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. The left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 50%. There is basal to mid inferior hypokinesis and thinning. There is late gadolinium enhancement extending from the basal to mid inferior walls, suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is patchy, however there a portions which appear to involve the sub-endocardium. The significance of this pattern is unclear, but could be explained by prior coronary disease.2. The right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 33%. No RV LGE was seen.3. Pacemaker lead is noted coursing to the RV apex.4. There is severe tricuspid regurgitation.5. Severe biatrial enlargement. 