A 16 year old male with known hypertrophic cardiomyopathy and family history of sudden cardiac death. A recent echocardiography showed hyperdynamic left ventricular function, severe asymmetric hypertrophy, no left ventricular outflow tract gradient despite a mild systolic anterior motion of the anterior leaflet of the mitral valve was noted. Referred Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 95 ml/m2 (normal range: 74+/-15), the LVEDV is 190 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 100 g/m2, and the LV mass is 199 g. There is severe asymmetric hypertrophy, while the maximal thickness was measured at the anterior basal septum (26mm). There is minimal flow acceleration at the left ventricular outflow tract and there is no SAM (systolic anterior movement of the anterior leaflet of the mitral valve). There are no regional wall motion abnormalities present, but myocardial deformation is abnormal within the hypertrophied segments. There are two focal areas of late gadolinium enhancement, one in the basal-to-mid segments of the inferior wall and the second one in the mid segment of the anterior wall in a patchy pattern at the insertion points. Based on the full-width half maximum technique, 5-10% of the to myocardial mass has late gadolinium enhancement. Both enhancements are non-transmural and are atypical for myocardial infarction. These enhancements suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1-times are diffusely increased, while the maximal times were noted at the septum and at the mid segments of the inferior wall (~1150-1200ms). No myocardial iron overload. No intracavitary thrombus.Left AtriumThe left atrium is normal in size (87ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 168 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 81 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, 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 and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.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 normal in size and systolic function. the LVEF is 67%. There is severe asymmetric hypertrophy, with a maximal thickness of 26mm at the anterior basal septum. 5-10% of the myocardial mass has evidence of late gadolinium enhancement, likely due to underlying fibrosis.2. The native myocardial T1-times are diffusely increased, while the maximal times were noted at the septum and at the mid segments of the inferior wall (~1150-1200ms), also suggesting the presence of underlying myocardial fibrosis. 3. The right ventricle is normal in size and systolic function, the RVEF is 52%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.