50 year old man with a history of ischemic cardiomyopathy status post heart transplant 4/30/15, referred for evaluation of pericardial disease and rejection. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 79 ml/m2 (normal range: 74+/-15), the LVEDV is 165 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 75 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 116 g (normal range 164+/-36). There is mild abnormal septal wall motion consistent with prior sternotomy. There are no other regional wall motion abnormalities present. The myocardial native T1 time is 1167ms (previously 1231ms on 12/2/15). This is elevated which can suggest the presence of an intra-myocardial process. However, it has decreased since prior MRI. The myocardial to skeletal T2 ratio is mildly elevated (2.2), previously it was less than 2. The cardiac output is 7.59L/min and the cardiac index is 3.62L/min/m2.Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 68 ml/m2 (normal range 82+/-16), the RVEDV is 143 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 60 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.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 trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a combined right innominate and left common carotid or "pseudo-bovine" branching pattern, which is a normal variant. 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.PericardiumThe pericardium is thickened (6 mm maximal). The pericardium is bright on T2-weighted imaging suggesting that it is edematous/ inflamed. There is no obvious pericardial to myocardial tethering noted on the current study. On real-time cine imaging, there is no evidence of interventricular dependence. There is a small loculated pericardial effusion adjacent to the right atrium. There is a significant amount of pericardial fat present.Extracardiac FindingsThere are sternotomy wires present. There is gynecomastia. A catheter is noted in the SVC. 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 normal in size and systolic function. The overall LV ejection fraction is 55%. The native myocardial T1 time is elevated suggesting that there may be an intramyocardial process present. However the value has decreased since prior MRI on 12/2/15, indicating improvement in the underlying process. The cardiac output has also increased compared to the prior study. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%. The RVEF has increased compared to the prior study. 3. The pericardium is thickened with evidence of edema/ inflammation. However, based on real-time cine imaging, there does not appear to be interventricular dependence. These finding suggest that there is ongoing pericarditis but the abnormality does not appear to be causing constrictive physiology.4. There is a small loculated pericardial effusion adjacent to the right atrium. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.