48 year old woman with history of hypertrophic cardiomyopathy and subaortic membrane s/ septal myectomy in June 2016, with persistent exertional dyspnea and evidence of residual LVOT gradient on echocardiography, referred for cardiac MRI to quantify gradient and risk stratification. Left VentricleThe left ventricle is severely dilated with hyperdynamic systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 124 ml/m2 (normal range: 65+/-11), the LVEDV is 242 ml (normal range 109+/-23), the LV end systolic volume index is 39 ml/m2 (normal range 18+/-5), the LVESV is 77 ml (normal range 31+/-10), the LV mass index is moderately elevated at 108 g/m2 (normal range 67+/-11), and the LV mass is 211 g (normal range 114+/-24). There is asymmetric hypertrophy of the basal anteroseptum (23 mm wall thickness versus 14 mm in the inferolateral wall). There are no regional wall motion abnormalities present. There is late gadolinium enhancement in the inferoseptal region associated with RV insertion point which suggests the presence of an underlying fibrosing, infiltrative process.Left AtriumThe left atrium is moderately dilated.Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 107 ml/m2 (normal range 69+/-14), the RVEDV is 208 ml (normal range 110+/-24), the RV end systolic volume index is 46 ml/m2 (normal range 22+/-8), and the RVESV is 90 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve is tri-leaflet and opens widely. There is flow acceleration through the LVOT/aortic valve, the peak velocity of which is estimated between 2.0-2.5m/s. The regurgitant fraction is consistent with mild aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is systolic anterior motion of the mitral valve with suggestion of chordal component and at least mild-moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsCholelithiasis. Sternotomy wire 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. Severely dilated left ventricle with hyperdynamic systolic function (EF 68%).2. The left ventricular mass index is moderately elevated with asymmetric hypertrophy of the basal septum. There is systolic anterior motion of the mitral valve with likely chordal component and evidence of flow acceleration in the LVOT between 2.0 - 2.5m/s and a corresponding gradient of 16-25 mmHg. This constellation of these findings suggests residual obstructive physiology.3. There is late gadolinium enhancement in the inferoseptal region associated with RV insertion point which suggests the presence of an underlying fibrosing, infiltrative inflammatory process.4. The aortic valve is tri-leaflet. The regurgitant fraction is consistent with mild aortic regurgitation.5. Moderate left atrial dilation.