29 year old male, with a history of renal failure, pulmonary hypertension, right ventricular enlargement, tricuspid regurgitation, and PFO with right to left shunt on echocardiogram bubble study. Presents for cardiovascular MRI to evaluate cardiac structure and function. Left VentricleThe left ventricle is normal in size and systolic function. There is severe concentric left ventricular hypertrophy. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 102 ml/m2 (normal range: 74+/-15), the LVEDV is 161 ml (normal range 142+/-34), the LV end systolic volume index is 37 ml/m2 (normal range 25+/-9), the LVESV is 59 ml (normal range 47+/-19), the LV mass index is 160 g/m2 (normal range 85+/-15), and the LV mass is 252 g (normal range 164+/-36). Septal thickness is 15mm. Posterior wall thickness is 15mm. There are no regional wall motion abnormalities present. No ventricular septal defect is noted. Right VentricleThe right ventricle is severely dilated with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 239 ml/m2 (normal range 82+/-16), the RVEDV is 377 ml (normal range 142+/-31), the RV end systolic volume index is 150 ml/m2 (normal range 31+/-9), and the RVESV is 237 ml (normal range 54+/-17).AtriaThe left atrium is normal in size. The right atrium is moderate to severely dilated. The inter-atrial septum bows to the left, suggesting increased right atrial pressure. No obvious atrial septal defect is noted; however, image quality is limited by the patient's inability to cooperate with breath-holds.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation. The valve is trileaflet.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation. The valve is trileaflet.Tricuspid ValveThe tricuspid valve opens widely. There is moderate to 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 mildly dilated (33mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSignificant abdominal ascites is noted. 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. Normal left ventricular size and systolic function (LVEF 63%), with severe concentric left ventricular hypertrophy.2. Severely dilated right ventricle with moderately reduced systolic function (RVEF 37%).3. Mild mitral insufficiency.4. Moderate to severe tricuspid insufficiency.5. Moderate to severe right atrial dilation.6. No obvious atrial septal defect is noted; however, image quality is limited by patient's inability to cooperate with breath-holds. No anomalous pulmonary venous drainage noted. No ventricular septal defect noted. 7. Significant abdominal ascites present.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.