38 year old man with history of a mechanical aortic valve replacement in 2009, recent TIA like symptoms and discordant left ventricular function on recent transthoracic echocardiogram versus transesophageal echocardiogram. He was referred for cardiac MRI to evaluate LV function. Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 120 ml/m2 (normal range: 74+/-15), the LVEDV is 222 ml (normal range 142+/-34), the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9), the LVESV is 112 ml (normal range 47+/-19), the LV mass index is 57 g/m2 (normal range 85+/-15), and the LV mass is 105 g (normal range 164+/-36). Wall motion appears mildly hypokinetic with no regional wall motion abnormalities.Left AtriumThe left atrium is stable in size. Right VentricleThe right ventricle is upper normal in size with mildly reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 113 ml/m2 (normal range 82+/-16), the RVEDV is 209 ml (normal range 142+/-31), the RV end systolic volume index is 68 ml/m2 (normal range 31+/-9), and the RVESV is 126 ml (normal range 54+/-17).Right AtriumThe right atrium is mild-moderately dilated.Aortic ValveThere is a prosthesis in the aortic position consistent with the patient's history of valve replacement. There is an interposition graft with the anastomosis at the level of the PA.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. No interval aneurysm.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 no pericardial effusion.
When compared to the previous MRI of 4/23/2009:1. LV function remains dilated with mildly reduced systolic function. The LVEF =50%, compared to 59%, previously. 2. The right ventricle systolic function has somewhat worsened, with an EF of 40%, compared to 49%.3. A mechanical valve is now located in the aortic position. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.