70 year old man with history of CAD s/p CABG, bioprosthetic AVR, pulmonary hypertension with evidence of possible pulmonary AVM on echocardiogram, referred for cardiac MRI. Left VentricleThe left ventricle is normal in size with mild to moderately reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 190 ml (normal range 142+/-34), the LV end systolic volume index is 52 ml/m2 (normal range 25+/-9), the LVESV is 114 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 112 g (normal range 164+/-36). There is abnormal septal motion. There is no definitive late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no LV thrombus.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with moderately reduced systolic function. The overall RV ejection fraction is 33%, the RV end diastolic volume index is 125 ml/m2 (normal range 82+/-16), the RVEDV is 272 ml (normal range 142+/-31), the RV end systolic volume index is 83 ml/m2 (normal range 31+/-9), and the RVESV is 181 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThere is a bioprosthesis in the aortic position with some evidence of flow acceleration. No significant regurgitation noted.Mitral ValveThe mitral valve opens widely. There is thickening of the leaflet tips. There is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease. The pericardial does not appear thickened or inflamed. Real time imaging did not reveal interventricular dependence with deep inspiration. Although there may be some myocardial to pericardial tethering along the posterior aspect of the ventricle, there is no obvious hemodynamic evidence of pericardial constriction. Extracardiac FindingsPrevious sternotomy wires with associated artifact. Increased interstitial lung markings. Large left renal cyst. Mediastinal lymphadenopathy noted. 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 mild to moderately reduced systolic function (EF 40%) without obvious evidence of infiltrative, inflammatory, or fibrotic process. 2. Moderately dilated RV with moderately reduced systolic function (EF 33%).3. Although there may be some myocardial to pericardial tethering along the posterior aspect of the ventricle, there is no obvious hemodynamic evidence of pericardial constriction. 4. At least moderate mitral and tricuspid regurgitation.5. Mild main pulmonary artery dilation. 6. No evidence of obvious pulmonary AVMs or fistulas. 7. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.