A 67 year old female with hypertension, hyperlipidemia and mitral valve prolapse. A recent echocardiography showed significant mitral and aortic regurgitation and suspected hypertrophic cardiomyopathy. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 96 ml/m2 (normal range: 65+/-11), the LVEDV is 159 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 38 g/m2 (normal range 67+/-11), and the LV mass is 62 g (normal range 114+/-24). There is mild focal hypertrophy of the basal anterior wall (12mm). The posterior wall thickness is 8mm. There is a significant left ventricular outflow tract gradient secondary to systolic anterior motion of the mitral leaflet and the above mentioned focal region of hypertrophy.There are no regional wall motion abnormalities present and intra-myocardial deformation within the hypertrophied segment is relatively normal. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No myocardial iron overload was noted.No intracavitary thrombus was seen.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 75 ml/m2 (normal range 69+/-14), the RVEDV is 123 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 54 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation (regurgitant fraction 13%).Mitral ValveThe mitral valve opens widely and there is at least moderate to severe mitral regurgitation likely secondary to significant systolic anterior motion of mitral leaflets. Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a pseudo-bovine brachiocephalic branching pattern. The ascending thoracic aorta is mildly dilated (40mm). The thoracic aorta is mild to moderately tortuous.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 a trivial pericardial effusion.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. The left ventricle is mildly dilated with normal systolic function, the LVEF is 64%. 2. There is mild focal hypertrophy of the basal anterior wall which is associated with significant systolic anterior motion of the mitral leaflets resulting in a substantial left ventricular outflow tract gradient and at least moderate to severe mitral regurgitation. Based on myocardial tagging, the intra-myocardial deformation within the hypertrophied segment is relatively normal. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process within the hypertrophied segment or elsewhere in the left ventricle. Although definitive diagnostic criteria for hypertrophic cardiomyopathy are not met on this MRI study and the morphology of the hypertrophy is consistent with a sigmoid septum associated with aging, a variant of hypertrophic cardiomyopathy remains on the differential diagnosis given the severity of the systolic anterior motion of the mitral leaflets and the presence of a basal anterior wall to posterior wall ratio of 1.5. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 56%. 4. The left atrium is moderately dilated. 5. The ascending aorta is mildly dilated and there is mild aortic regurgitation. 6. There is at least moderate to severe mitral regurgitation secondary to systolic anterior motion of the mitral leaflets.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.