A 53 year old male with history of inappropriate sinus tachycardia with ablation (endo and epicardial approach) in 12/2013 who developed constrictive pericarditis which was treated surgically with pericardial stripping by robotic approach (9/2014): extensive fibrosis was seen near epicardial ablation site (sinus node region). Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 78 ml/m2 (normal range: 74+/-15), the LVEDV is 161 ml (normal range 142+/-34), the LV end systolic volume index is 26 ml/m2 (normal range 25+/-9), the LVESV is 56 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 94 g (normal range 164+/-36). No interventricular septal bounce. There is basal inferior mid myocardial and lateral epicardial enhancement which may be from prior myocarditis and/or ablation.No intracardiac thrombus.Left AtriumThe left atrium is mildly dilated. Aneurysmal interatrial septum bowing to the left.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 84 ml/m2 (normal range 82+/-16), the RVEDV is 179 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 79 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.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 tricuspid regurgitation, not quantified but visually estimated to be mild.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The thoracic aorta is normal in size.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 discontinuation of the anterior pericardium consistent with prior partial pericardectomy. The pericardium is slightly thickened along the right atrium and is of low signal; however, does not appear calcified on recent chest radiograph. Fine calcification may be better detected with CT, if necessary. No pericardial enhancement.Extracardiac FindingsPost surgical findings in the thorax with increased signal favoring scar and or atelectasis of the lingula, leftward mediastinal shift and adhesions in the anterior mediastinum. Incidental azygous lobe.
1. The left ventricle is normal in size with normal systolic function, the LVEF is 65%. There is abnormal septal motion of unclear significance. LV enhancement may be sequela of prior ablation or inflammatio2. 2. The right ventricle is normal in size with normal systolic function, the RVEF is 56%. 3. No evidence of pericardial constriction. Normal sized right atrium with leftward aneurysmal interatrial septum, enlarged left atrium.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.