44 y/o man with developmental delay referred for evaluation for possible hypertrophic cardiomyopathy. Left VentricleThe left ventricle is moderately enlarged with overall normal systolic function, there is asymmetric hypertrophy (IVSd 17mm and PWd 9mm). The overall LV ejection fraction is 55%, the LV end diastolic volume index is 127 ml/m2 (normal range: 74+/-15), the LVEDV is 299 ml (normal range 142+/-34), the LV end systolic volume index is 58 ml/m2 (normal range 25+/-9), the LVESV is 135 ml (normal range 47+/-19), the LV mass index is 69 g/m2 (normal range 85+/-15), and the LV mass is 163 g (normal range 164+/-36). There is a subtle wall motion abnormality in the mid inferoseptum. There is mild late gadolinium enhancement in the mid wall pattern involving the basal septum. There is extensive circumferential late gadolinium enhancement along the endocardial surface involving much of the mid to apical left ventricle. The LGE in the basal septum is atypical for prior myocardial infarction and likely represents underlying fibrosis. The remainder of late gadolinium enhancement could be due to either a large myocardial infarction or due to extensive fibrosis. Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 109 ml/m2 (normal range 82+/-16), the RVEDV is 257 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 114 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately enlarged.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. There is mild systolic anterior motion of the mitral valve chords associated with mild flow acceleration in the left ventricular outflow tract. 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.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. Hypertrophic cardiomyopathy with normal systolic function (LVEF 55%). The maximum wall thickness is 17mm; however, there is an extensive amount of late gadolinium enhancement as described above. The late gadolinium enhancement could be due to: (1) fibrosis related to hypertrophic cardiomyopathy; (2) myocardial infarction due to extrinsic compression of the coronary artery within the hypertrophied segment; (3) myocardial infarction due to coronary artery disease; or (4) a variety of other less likely possibilities.2. Normal RV size and systolic function (RVEF 56%).3. Moderate biatrial dilation.4. Mild systolic anterior motion of the mitral valve chords associated with mild flow acceleration in the LVOT.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.