83 year old man with history of bradycardia with dual chamber pacemaker, PVC s/p recent ablation, referred for cardiac MR to evaluate scar. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 167 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 86 ml (normal range 47+/-19), the LV mass index is 72 g/m2 (normal range 85+/-15), and the LV mass is 159 g (normal range 164+/-36). There is abnormal septal motion and apical hypokinesis. There is a small, focus of subendocardial late gadolinium enhancement in the basal lateral wall which is not transmural but extends to 2/3 of the wall thickness. Although the late gadolinium enhancement involves the endocardium, it is associated with normal wall thickness and is not likely to be secondary to a small focal myocardial infarction. It suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is [no]myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVEDV is 197 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 103 ml (normal range 54+/-17). A pacemaker lead terminates in the right ventricular apex. Right AtriumThe right atrium is normal in size. A pacemaker lead terminates within the right atrial appendage. Aortic ValveThe aortic valve opens widely. Qualitatively there is mild 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 no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated (44 mm at the sinus of Valsalva; 39 x 39mm ascending aorta.)Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (34mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. Pacemaker leads traverse the innominate and SVC into the right heart.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsA pacemaker is present in the right upper chest wall. 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 LV size with mildly reduced systolic function (EF 48%). There is a small focus of late gadolinium enhancement as described above which suggests the presence of a fibrosing, infiltrative, or inflammatory process. 2. Normal RV size with mildly reduced systolic function (EF 48%).3. Pacemaker leads within the SVC and right heart.4. Mild aortic regurgitation. 5. Mildly dilated aortic root. 6. Mildly dilated main pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.