38 year old with history of NICM s/p heart transplant in may 2015, hypertension, gout and constrictive pericarditis. Referred for cardiac MRI for follow up of constrictive pericarditis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 68 ml/m2 (normal range: 74+/-15), the LVEDV is 150 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 59 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 112 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying myocardial fibrosing, infiltrative, or inflammatory process. Native T1 times are moderately elevated at 1154 ms in the mid interventricular septum (similar to previous study).There is persistent mild diffuse hyperintensity of the interventricular septum on T2 STIR sequences, suggestive of persistent mild myocardial edema. Overall improvement in circumferential hyperintensity of the pericardium previously noted.Left AtriumThe left atrium is consistent with transplant morphology. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 165 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 76 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant morphology.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 at least mild 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. There is no stenosis at the anastomosis site.Venous AnatomyThe SVC is normal in size. There is IVC continuation of the azygous vein, which is enlarged and empties in the SVC normally. PericardiumThe pericardium is mildly thickened with evidence of increased T2-signal but no significant late gadolinium enhancement. Based on myocardial tagging, the pericardium is tethered to the myocardium. On real time cine imaging, there is no obvious interventricular discordance during respiration noted. There is a small, loculated pericardial effusion located apico-posteriorly. Extracardiac FindingsThere are no pleural effusions. Sternotomy wires are present. 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. New right atrial thrombus noted (15 x 13.5 mm).2. The pericardium is mildly thickened (decreased compared to previous) with evidence of cyst and mild increased T2-signal but no significant late gadolinium enhancement. Based on myocardial tagging, the pericardium is likely tethered to the myocardium anteriorly although there are no findings to suggest constrictive pericarditis. 3. There is a small, loculated pericardial effusion located apico-posteriorly, stable from prior. 2. Normal left ventricular size and systolic function (LVEF 61%). The native myocardial T1 time is moderately elevated and unchanged. 3. Normal right ventricular size and systolic function (RVEF 54%). Notification of emergent findings from impression #1 were communicated to Jodel Powers, APN (APN to Dr. G. Sayers).