71 year old man with history of reported hypertrophic CM, longstanding HTN, question of aortic stenosis on recent echocardiogram with exertional dyspnea and chest pain, referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 103 ml/m2 (normal range: 74+/-15), the LVEDV is 200 ml (normal range 142+/-34), the LV end systolic volume index is 37 ml/m2 (normal range 25+/-9), the LVESV is 71 ml (normal range 47+/-19), the LV mass index is 92 g/m2 (normal range 85+/-15), and the LV mass is 177 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is asymmetric hypertrophy of the left ventricle. It is severely hypertrophied in the basal anteroseptum and moderately hypertrophied in the basal lateral wall and the mid to apical septum . The remainder of the ventricle is relatively normal wall thickness. The maximum wall thickness is 18mm. There is patchy late gadolinium enhancement in the basal to mid inferior wall at the RV insertion point which is atypical for previous myocardial infraction, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is flow acceleration noted in the LVOT (See below). Left AtriumThe left atrium is severely 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 79 ml/m2 (normal range 82+/-16), the RVEDV is 152 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 68 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet with thickening/ calcified of the cusps. By planimetry and peak velocity, there is at least moderate aortic valve stenosis. There is additionally mild aortic regurgitation. Mitral ValveThe mitral valve opens widely. There is systolic anterior motion of the mitral valve leaflets associated with mild to moderate mitral regurgitation and a left ventricular outflow tract gradient. 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 ascending aorta measures 37 x 38mm. 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBilateral renal cysts. Moderate right pleural effusion. 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. There is evidence of both aortic valve stenosis and hypertrophic cardiomyopathy. 2. The LV is normal in size with normal systolic function (EF 64%). There is asymmetric hypertrophy of the LV. It is severely hypertrophied in the basal anteroseptum and moderately hypertrophied in the mid to apical septum and the basal lateral wall . The remainder of the ventricle has relatively normal wall thickness. The maximum wall thickness is 18mm. 3. There is patchy late gadolinium enhancement in the basal to mid inferior wall at the RV insertion point which is atypical for previous myocardial infraction, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. 4. The RV is normal in size with normal systolic function (EF 56%). 5. At least moderate aortic valve stenosis. 6. There is systolic anterior motion of the mitral valve leaflets associated with mild to moderate mitral regurgitation and a left ventricular outflow tract gradient. 7. Severe left atrial dilation .8. Mild ascending aortic dilation. 9. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.