66 year old male with history of atrial flutter, hypertension, obstructive sleep apnea, diabetes with new, asymptomatic complete heart block. He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 101 ml/m2 (normal range: 74+/-15), the LVEDV is 235 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 107 ml (normal range 47+/-19), the LV mass index is 37 g/m2 (normal range 85+/-15), and the LV mass is 88 g (normal range 164+/-36). There is thinning of the mid to apical anterior and anteroseptal walls with associated hypokinesis. There is a non-transmural myocardial infarction involving this territory (mid to apical anterior and anteroseptal walls). This territory has an intermediate probability of viability. There is additionally another region of late gadolinium enhancement involving the mid-myocardium layer of the basal anteroseptum. This pattern of late gadolinium enhancement is not typical for myocardial infarction and suggests the presence of a focal secondary underlying fibrosing, infiltrative, or inflammatory process which may be the mechanism of the patient's heart block. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 91 ml/m2 (normal range 82+/-16), the RVEDV is 211 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 95 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.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 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 significantly dilated (43 mm)Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.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 mildly dilated with normal systolic function (LVEF 55%). 2. There is thinning of the mid to apical anterior and anteroseptal walls with associated hypokinesis. There is a non-transmural myocardial infarction involving this territory (mid to apical anterior and anteroseptal walls). This territory has an intermediate probability of viability. 3. There is additionally another region of late gadolinium enhancement involving the mid-myocardium layer of the basal anteroseptum. This pattern of late gadolinium enhancement is not typical for myocardial infarction and suggests the presence of a focal secondary underlying fibrosing, infiltrative, or inflammatory process which may be the mechanism of the patient's heart block. 4. The right ventricle is mildly dilated with normal systolic function (RVEF 55%). 5. Moderate biatrial enlargement. 6. Significant dilation of the main pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.