A 65 year old female with personal history of heart transplant (6/2015), hypertension, anxiety and GERD. Now hospitalized due to worsening shortness of breath concerning for transplant rejection. Found to have urinary tract infection. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 93 ml/m2 (normal range: 65+/-11), the LVEDV is 176 ml (normal range 109+/-23), the LV end systolic volume index is 46 ml/m2 (normal range 18+/-5), the LVESV is 86 ml (normal range 31+/-10), the LV mass index is 51 g/m2 (normal range 67+/-11), and the LV mass is 95 g (normal range 114+/-24). There is mild global hypokinesis with regional variation. There is a small focus of late gadolinium enhancement involving the anterior right ventricular insertion point of the left ventricle suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is mild to moderate increase in native myocardial T1-times (1150ms).The Global Relative enhancement (3.78), t2-STIR edema ratio (1.9), and the extra-cellular volume fraction (25%) are all within normal. No intracavitary thrombus was noted.Left AtriumThe left atrium is dilated consistent with transplant morphology. The LA volume is 102 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 87 ml/m2 (normal range 69+/-14), the RVEDV is 165 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 81 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve 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 are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease. There is a trivial pericardial effusion.Extracardiac FindingsPost heart transplant surgery findings. 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 left ventricle is mildly dilated with low normal systolic function, the LVEF is 51%. There is mild global hypokinesis with regional variation. 2. There is a small focus of late gadolinium enhancement involving the anterior right ventricular insertion point of the left ventricle suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. This is supported by the mild to moderate increase in native myocardial T1-times. The other parameters that might support myocardial inflammation are within normal limits (Global Relative enhancement, t2-STIR edema ratio, and the extra-cellular volume fraction).3. The right ventricle is normal in size with normal systolic function, the RVEF is 51%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.