52 year old female with a history of non-ischemic cardiomyopathy, status post mitral valve and tricuspid valve replacement, atrial fibrillation. She was referred for cardiac MRI to evaluate fibrosis burden. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 184 ml/m2 (normal range: 65+/-11), the LVEDV is 285 ml (normal range 109+/-23), the LV end systolic volume index is 157 ml/m2 (normal range 18+/-5), the LVESV is 247 ml (normal range 31+/-10), the LV mass index is 102 g/m2 (normal range 67+/-11), and the LV mass is 158 g (normal range 114+/-24). There are global hypokinesis present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.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 18%, the RV end diastolic volume index is 155 ml/m2 (normal range 69+/-14), the RVEDV is 240 ml (normal range 110+/-24), the RV end systolic volume index is 128 ml/m2 (normal range 22+/-8), and the RVESV is 198 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveStatus post bioprosthetic mitral valve replacement, and there is mild central mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveStatus post tricuspid valve annuloplasty. There is mild to moderate 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 (MPA 34mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. There is a catheter in SVC.PericardiumThere is no pericardial effusion; however, there is evidence of late gadolinium enhancement of the pericardium suggesting the presence of underlying fibrosis or inflammation.Extracardiac FindingsTrace pleural effusion. 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. Severely reduced biventricular dysfunction (LVEF 14% and RVEF 18%)without evidence of underlying myocardial fibrosing, infiltrative, or inflammatory process.2. Status post mitral valve replacement with there is mild central mitral regurgitation.3. Status post tricuspid valve annuloplasty ring. There is mild to moderate tricuspid regurgitation.4. Severe biatrial dilation.5. There is evidence of late gadolinium enhancement of the pericardium suggesting the presence of underlying fibrosis or inflammation.6. Main pulmonary artery is mildly dilated. 7. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.