38 year old man with history of a mechanical aortic valve replacement in 2009, recent TIA like symptoms and discordant left ventricular function on recent transthoracic echocardiogram versus transesophageal echocardiogram. He was referred for cardiac MRI to evaluate LV function. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 96 ml/m2 (normal range: 74+/-15), the LVEDV is 224 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 70 ml (normal range 47+/-19), the LV mass index is 68 g/m2 (normal range 85+/-15), and the LV mass is 158 g (normal range 164+/-36). There is mild left ventricular hypertrophy (IVSd=11mm). There are no regional wall motion abnormalities present. There is a focal area of patchy late gadolinium enhancement in the basal inferolateral and anterolateral walls which is atypical for prior myocardial infarction. The native myocardial T1 time is borderline elevated in the mid ventricular septum (1060ms); however, in the basal inferolateral wall, the native myocardial T1 time is significantly elevated (1301ms). These findings are abnormal but not specific for a particular disorder. The differential diagnosis includes early cardiac amyloidosis, myocarditis, and other infiltrative processes. Repeat cardiac MRI study in 6-12 months to assess for changes may help clarify the diagnosis. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 226 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 100 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation. Posterior mitral valve leaflet motion is somewhat restricted.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 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 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. Normal left ventricular size with hyperdynamic systolic function (EF = 69%) with mild concentric left ventricular hypertrophy (IVSd=11mm). There is a focal area of transmural, patchy late gadolinium enhancement in the basal inferolateral and anterolateral walls. The pattern is not consistent with prior myocardial infarction but the differential diagnosis includes early cardiac amyloidosis, myocarditis, and other infiltrative processes. Repeat cardiac MRI study in 6-12 months to assess for changes in this area may help clarify the diagnosis. 2. Normal right ventricular size with normal systolic function.3. Moderate biatrial dilation.4. Mild to moderate mitral regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.