5 year old man with a history of ischemic cardiomyopathy, s/p heart transplant (4/30/2015) and antibody mediated rejection, hypertension and diabetes, referred for evaluation of rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 58 ml/m2 (normal range: 74+/-15), the LVEDV is 138 ml (normal range 142+/-34), the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9), the LVESV is 59 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 125 g (normal range 164+/-36). There is mild concentric left ventricular hypertrophy (11-12mm). There are no regional wall motion abnormalities present. T2 edema ratio is <2, which is normal. Global relative enhancement value is 2.4, which is normal and decreased when compared to the study from May 2016. The myocardial native T1 time is 1106 ms in the mid ventricle, which is borderline elevated but improved from the previous study. Additionally, the extracellular volume fraction is not elevated. There is a small area of patchy late gadolinium enhancement in the mid inferoseptum, which is similar to the previous contrast study (MRI dated 5/3/2016). It is atypical of myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is enlarged consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 133 ml (normal range 142+/-31), the RV end systolic volume index is 27 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is enlarged consistent with transplant.Aortic ValveThe aortic valve 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 mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a "pseudo-bovine" brachiocephalic branching pattern (normal variant). 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.PericardiumNo residual pericardial inflammation noted. Extracardiac FindingsSternotomy wires are present. Interval resolution of small left pleural effusion. 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 (EF 57%) with mild left ventricular hypertrophy which is stable compared to the previous study. There is the stable appearance of mild late gadolinium enhancement in the basal inferoseptum which has been previous observed. Otherwise, there is no evidence of acute myocardial edema on T2-STIR imaging, and the native T1 myocardial relaxation times and the ECV fractions have decreased when compared to the previous study of 5/3/2016.2. Normal size right ventricle with normal systolic function (EF 52%).3. No residual pericardial inflammation or evidence of respirophasic septal shift on this study. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.