60 year-old male with atrial fibrillation and obstructive sleep apnea found to have new pulmonary hypertension. Right heart cath revealed ASD with Qp:Qs 1.55. CMR ordered to further evaluate. Patient polish-speaking. Did not speak any English. Translator present but patient frequently not able to follow commands. Patient had a significant amount of difficulty holding his breath during the study and especially during the short axis sequences and axial stack. LV and RV volumes are estimates at best. Endocardial borders were difficult to delineate with accuracy. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 44%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 195 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. Poor quality late gadolinium enhancement images due to inability to follow breathing instructions.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with moderately reduced systolic function. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 264 ml/m2 (normal range 82+/-16), the RVEDV is 587 ml (normal range 142+/-31), the RV end systolic volume index is 183 ml/m2 (normal range 31+/-9), and the RVESV is 406 ml (normal range 54+/-17). Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is at least mild aortic regurgitation.Mitral ValveThe mitral valve opens widely. Unable to assess degree of mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThe aortic root measured 39 mm in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated. The main PA size is 50 mm, the right PA size is 32 mm, and the left PA size is 38 mm.Venous AnatomyThe SVC and IVC drain normally into the right atrium. ShuntsThere is a large secundum ASD present measuring ~30 mm in the 4-chamber view with evidence of both right to left and left to right shunting. Qp:Qs could not be calculated as the software for calculation was not functional. Images were suboptimal for rim assessment.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. Technically challenging study due to language barrier and patient difficulty with breath-holds2. The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 44%. Largely non-diagnostic late gadolinium images.3. The right ventricle is severely dilated with moderately reduced systolic function. The overall RV ejection fraction is 31%4. There is a large secundum ASD present measuring ~30 mm in the 4-chamber view with evidence of both right to left and left to right shunting. 5. At least moderate tricuspid regurgitation