51 year old male with tachycardia-induced cardiomyopathy, atrial flutter 2:1, primum ASD s/p repair age 7 years ago, cleft mitral valve, APVR, likely interrupted IVC with azygous continuation. Referred for MRI evaluation of anatomy and function. Left VentricleThe left ventricle is moderately to severely dilated with moderately depressed systolic function. The overall LV ejection fraction is 36%. The LVEDV is 320 ml (normal range 142+/-34), the LV end diastolic volume index is 154 ml/m2 (normal range: 74+/-15), the LVESV is 204 ml (normal range 47+/-19) and the LV end systolic volume index is 98 ml/m2 (normal range 25+/-9). The LV mass is 143 g (normal range 164+/-36) and the LV mass index is 69 g/m2 (normal range 85+/-15). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation times are mildly elevated (1140-1190 ms) in the interventricular septum and the left ventricular lateral wall which are mildly elevated. These values are suggestive of underlying mild diffuse fibrosis or infiltration.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is severely dilated. Previous atrial septal defect repair is noted with 2 small residual defects apparent, one at the proximal end of the repair site and the other at the distal end of the repair site.Right VentricleThe right ventricle is severely dilated with severely depressed systolic function. The overall RV ejection fraction is 16%. The RVEDV is 410 ml (normal range 142+/-31), RV end diastolic volume index is 197 ml/m2 (normal range 82+/-16), the RVESV is 344 ml (normal range 54+/-17), and the RV end systolic volume index is 165 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is at least mildly dilated.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely but there appears to be moderate to severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is at least mild-moderate pulmonic regurgitation. There is inadequate data to quantify PR on this study.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsThree pulmonary veins drain normally into the left atrium. The right lower pulmonary vein drains into the left atrium. The right upper pulmonary vein, however drains into a confluence that could be part of a baffle system which then enters the left atrium. Pulmonary ArteryThe main pulmonary artery is dilated (41 mm). The branch pulmonary ateries bifurcate at the same level.Venous AnatomyThe SVC drains normally into the right atrium. The infra-hepatic segment of the IVC is absent. The hepatic veins drain into the right atrium. There is a significantly dilated azygous vein which drains into the SVC. The coronary sinus drains into the left atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are some enlarged paratracheal lymph nodes noted. The bronchial anatomy is consistent with left isomerism (both right and left bronchi are hyparterial). 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 moderately to severely dilated with moderately depressed systolic function. The overall LV ejection fraction is 36%.The native T1 myocardial relaxation times are mildly elevated (1140-1190 ms) in the interventricular septum and the left ventricular lateral wall which are mildly elevated. These values are suggestive of underlying mild diffuse fibrosis or infiltration.2.The right ventricle is severely enlarged with severely depressed systolic function. The overall RV ejection fraction is 16%.3.There is moderate-severe mitral regurgitation4.There is at least mild-moderate pulmonary regurgitation5.There is severe left atrial dilation. 6.Three pulmonary veins drain normally into the left atrium. The right lower pulmonary vein drains into the left atrium. The right upper pulmonary vein, however drains into a confluence that could be part of a baffle system which then enters the left atrium. 7.Previous atrial septal defect repair is noted with 2 small residual defects apparent above and below the repair site.8.The SVC drains normally into the right atrium. The infra-hepatic segment of the IVC is absent. The hepatic veins drain into the right atrium. There is a significantly dilated azygous vein which drains into the SVC. 9.The coronary sinus drains into the left atrium.10.There are some enlarged paratracheal lymph nodes noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.