45 year old woman with advanced heart failure, referred for evaluation of viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 22%, the LV end diastolic volume index is 164 ml/m2 (normal range: 65+/-11), the LVEDV is 260 ml (normal range 109+/-23), the LV end systolic volume index is 127 ml/m2 (normal range 18+/-5), the LVESV is 202 ml (normal range 31+/-10), the LV mass index is 76 g/m2 (normal range 67+/-11), and the LV mass is 121 g (normal range 114+/-24). LV dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 153 ml/m2 (normal range 69+/-14), the RVEDV is 244 ml (normal range 110+/-24), the RV end systolic volume index is 107 ml/m2 (normal range 22+/-8), and the RVESV is 170 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is severe 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 a small pericardial effusion. Extracardiac FindingsThere are moderate bilateral pleural effusions with lung atelectasis vs infection . In the right lung, there is either a mass or infiltrate and the pleural effusion are complex appearing with evidence of septations. 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. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 22%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The entire myocardium is viable. Image quality is somewhat limited by patient have difficulty with breath-holds.2. The right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 30%.3. Severe biatrial enlargement4. Severe mitral and tricuspid regurgitation.5. Right lung mass vs infiltrate associated with significant, complex appearing pleural effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.