50 year old woman with history of hypertension, diabetes, admitted with new diagnosis of heart failure and recent URI, referred for cardiac MRI to evaluate for underlying etiologies/ rule out myocarditis. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 125 ml/m2 (normal range: 65+/-11), the LVEDV is 252 ml (normal range 109+/-23), the LV end systolic volume index is 83 ml/m2 (normal range 18+/-5), the LVESV is 169 ml (normal range 31+/-10), the LV mass index is 71 g/m2 (normal range 67+/-11), and the LV mass is 144 g (normal range 114+/-24). LV dysfunction is global with regional variation. There is no evidence of increased T2-signal to suggest myocardial edema. There is no evidence of early gadolinium enhancement to suggest capillary leak/ inflammation. There is no late gadolinium enhancement to suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. T2-star time is normal suggesting no myocardial iron overload. Left AtriumThe left atrium is moderate-severely increased in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 69 ml/m2 (normal range 69+/-14), the RVEDV is 139 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 66 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is bi-leaflet tethering of the mitral valve. There is severe 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 bovine 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are small bilateral pleural effusions, right greater than left. See recent CT chest for lung details. 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. Severe LV dilation with moderately reduced LV systolic function (LVE F33%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 53%).3. Moderate to severe left atrial dilation.4. Severe mitral regurgitation due to bileaflet tethering.5. Mild main pulmonary artery dilation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.