37 year old with history of heart transplant in may 2015, hypertension, hyperglycemia presenting with pericardial effusion s/p drainage. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 67 ml/m2 (normal range: 74+/-15), the LVEDV is 151 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 68 ml (normal range 47+/-19), the LV mass index is 56 g/m2 (normal range 85+/-15), and the LV mass is 126 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying myocardial fibrosing, infiltrative, or inflammatory process. Native T1 times are moderately elevated at 1160 ms in the mid interventricular septum. Left AtriumThe left atrium is consistent with transplant morphology. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 178 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant morphology.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 normal in size.Venous AnatomyThe SVC is normal in size. There is IVC continuation of the azygous vein, which is enlarged and empties in the SVC normally. PericardiumThe pericardium is moderately thickened with evidence of increased T2-signal and late gadolinium enhancement of the visceral and parietal pericardium. Based on myocardial tagging, the pericardium is tethered to the myocardium. On real time cine imaging, there is no obvious interventricular discordance during respiration noted. There is a small, loculated complex appearing pericardial effusion located posteriorly. Extracardiac FindingsThere are small bilateral pleural effusions, left greater than right. Sternotomy wires are present. 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. The pericardium is moderately thickened with evidence of increased T2-signal and late gadolinium enhancement of the visceral and parietal pericardium. Based on myocardial tagging, the pericardium is tethered to the myocardium. On real time cine imaging, there is no obvious interventricular discordance during respiration noted. There is a small, loculated complex appearing pericardial effusion located posteriorly. These findings suggest that the pericardium is significantly inflamed. 2. Normal left ventricular size and systolic function (LVEF 55%) without evidence of underlying myocardial late gadolinium enhancement suggesting the absence of replacement fibrosis or overt inflammation; however, the native myocardial T1 time is moderately elevated which could be seen in the setting of subclinical edema or mild diffuse interstitial fibrosis. 3. Normal right ventricular size and systolic function (RVEF 59%). 4. Small bilateral pleural effusions noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.