50 year old female with frequent PVCs from the RVOT, decreased EF and decreased exercise tolerance. Referred for MRI evaluation for possible infiltrative disorders/ARVC. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 41%. The LVEDV is 212 ml (normal range 109+/-23), LV end diastolic volume index is 116 ml/m2 (normal range: 65+/-11), LVESV is 125 ml (normal range 31+/-10), and LV end systolic volume index is 68 ml/m2 (normal range 18+/-5). The LV mass is 91 g (normal range 114+/-24) and the LV mass index is 50 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is late gadolinium enhancement involving the epicardial basal inferolateral wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is moderately dilated with normal systolic function. The overall RV ejection fraction is 58%, the RVEDV is 188 ml (normal range 110+/-24), the RV end diastolic volume index is 103 ml/m2 (normal range 69+/-14), the RVESV is 80 ml (normal range 35+/-13), and the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8). There are no focal RV aneurysms noted. Right AtriumThe right atrium is mildly dilated. There is a small patent foramen ovale with a left to right shunt.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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 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 drain normally into the right atrium. PericardiumThere is a small 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 severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 41%. There is evidence of myocardial fibrosis, inflammation, or infiltration involving the basal inferolateral wall. The pattern of involvement is atypical for prior myocardial infarction. 2.The right ventricle is moderately dilated with normal systolic function. The overall RV ejection fraction is 58%. No evidence of obvious focal right ventricular aneurysms. No major CMR criteria for the diagnosis of arrhythmogenic right ventricular cardiomyopathy. 3.There is likely a small patent foramen ovale with a left to right shunt.4.Mild right atrial and moderate left atrial dilation.5.Small pericardial effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.