72 year old with history of hypertension, diabetes, chronic kidney disease, valvular heart disease, coronary artery disease (CABG 2014) and diastolic heart failure presenting from OSH with acute decompensated heart failureTechnical: The quality is poor, due to inability to perform breath hold and motion artifact Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 106 ml/m2 (normal range: 74+/-15), the LVEDV is 252 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 103 ml (normal range 47+/-19), the LV mass index is 87 g/m2 (normal range 85+/-15), and the LV mass is 208 g (normal range 164+/-36). There is septal flattening at inspiration and expiration consistent with RV pressure and volume overload. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, however LGE imaging significantly limited by motion artifact.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 145 ml/m2 (normal range 82+/-16), the RVEDV is 346 ml (normal range 142+/-31), the RV end systolic volume index is 72 ml/m2 (normal range 31+/-9), and the RVESV is 171 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThere is a prosthetic valve in the aortic position. 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 moderate-severe eccentric 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 and drain normally into the right atrium. The IVC is dilated.PericardiumThe pericardium is borderline thickened in some regions (the maximum measured thickness is only 4mm). Based on tagging, the myocardium does not appear adherent to the pericardium. Free breathing does not show significant interventricular dependence to support constrictive physiology. Extracardiac FindingsSternotomy wires present. Bilateral interstitial markings, left greater than right. 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. This is a technically difficult study because of patient inability to cooperate with breath-holds. Within the limitations of image quality, it can be noted that the pericardium is at most borderline thickened. There is no obvious evidence of pericardial tethering to the myocardium or respiratory variation in the septal position. There is also no significant late gadolinium enhancement of the pericardium. Taken together there is no strong evidence for pericardial constriction.2. Mild LV dilation with normal systolic function (LVEF 59%) with septal flattening which seems to occur more often during systole suggesting the presence of increased RV systolic pressures. There is no obvious late gadolinium enhancement to suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration; however, image quality is somewhat limited. 3. Severe RV dilation with normal systolic function (RVEF 51%).4. Moderate to severe tricuspid regurgitation. 5. Severe RA dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.