A 69 year old male with Marfan's syndrome and aortic dilatation referred to cardiac MRI for interval follow up of aortic dimensions. Left VentricleThe left ventricle is severely dilated with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 131 ml/m2 (normal range: 74+/-15), the LVEDV is 302 ml (normal range 142+/-34), the LV end systolic volume index is 62 ml/m2 (normal range 25+/-9), the LVESV is 144 ml (normal range 47+/-19), the LV mass index is 64 g/m2 (normal range 85+/-15), and the LV mass is 148 g (normal range 164+/-36). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size (92ml). Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 115 ml/m2 (normal range 82+/-16), the RVEDV is 265 ml (normal range 142+/-31), the RV end systolic volume index is 56 ml/m2 (normal range 31+/-9), and the RVESV is 130 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated (157ml).Aortic ValveThe aortic valve opens widely and there is moderate aortic regurgitation (regurgitant fraction 21%). The aortic valve is trileaflet. 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 to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. No evidence of aortic dissection. The aortic root is aneurysmal. The following orthogonal (double oblique) dimensions were obtained of the thoracic aorta (MRA). Additionally the measurements were repeated using the same technique on the 2012 study and also the October 2015 study for direct comparison:Sinus of Valsalva: 53 x 53 x 49mm (from commissure to sinus). On the 2012 study = 52x52x51mm Sinotubular junction: 49 x 50mm. On the 2012 study = 50x47mmMid ascending aorta at the level of the main pulmonary artery: 45 x 45mm. On the 2012 study = 45x46mm.Ascending aorta immediately proximal to the innominate artery: 44 x 42mmDescending Aorta: 26 x 26mmPulmonary 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 severely dilated with low normal systolic function, the LVEF is 52%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is mildly dilated with normal systolic function, the RVEF is 51%. 3. The right atrium is severely dilated (157ml).4. There is moderate aortic regurgitation (regurgitant fraction 21%).5. There is mild to moderate tricuspid regurgitation.6. The aortic root and ascending aorta are dilated. The measurements are reported above. Repeat measurement were made on the 10/2015 study and the 2012 study using identical measurement locations and techniques. When compared on a side-by-side basis to the 2012 study, the thoracic aorta is minimally more dilated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.