49 year old with history of heart transplant in 4/2015 with recent volume overload and hyponatremia presenting for evaluation of biventricular function and/or scar or fibrosis. Left VentricleThe left ventricle is normal in size with normal systolic function, there is mild concentric left ventricular hypertrophy. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 60 ml/m2 (normal range: 74+/-15), the LVEDV is 129 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 49 ml (normal range 47+/-19), the LV mass index is 36 g/m2 (normal range 85+/-15), and the LV mass is 78 g (normal range 164+/-36). There are no regional wall motion abnormalities present, there is mild paradoxical motion of the septum and anterior wall, possibly conductional in etiology. There is no late gadolinium enhancement or intracardiac thrombus.Left AtriumThe left atrium is within limits of normal size.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 59 ml/m2 (normal range 82+/-16), the RVEDV is 126 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 56 ml (normal range 54+/-17).Right AtriumThe right atrium normal size.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 no significant tricuspid regurgitation.AortaThere is a left sided aortic arch has a common origin to the right innominate and left common carotid artery. he aortic root is normal in size. The mid ascending aorta, at the level of the main pulmonary artery, demonstrates mild caliber change compatible with suture line from cardiac transplant. 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 are normal in size and drain normally into the right atrium.PericardiumThere is no significant pericardial effusion. There is a localized fluid collection lateral to the right atrium with signal changes suggestive of proteinaceous or possibly hemorrhagic component, suspected to be postoperative in nature. There is mild mediastinal lipomatosis. Extracardiac FindingsSternotomy wires present consistent with previous cardiac surgery. There is asymptomatic gynecomastia (left greater than right). This appears unchanged compared to CT chest 5/2015. Suggest correlation to physical examination. No associated lymphadenopathy. No pulmonary edema or pleural effusion
1. The left ventricle is normal in size with normal systolic function, there is mild concentric left ventricular hypertrophy (LVEF 62%). No abnormal enhancement is present.2. The right ventricle is normal in size and systolic function(RVEF 56%). 3. Localized fluid collection lateral to the right atrium, likely postoperative in nature.4. Asymmetric gynecomastia.