57 year old male with ICM s/p orthotopic heart transplant in 2003, new CHF, no significant coronary occlusion on cath. Referred for cardiac MRI to assess regional hypoperfusion. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%. The LVEDV is 205 ml (normal range 142+/-34), the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVESV is 70 ml (normal range 47+/-19) and the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9). The LV mass is 161 g (normal range 164+/-36) and the LV mass index is 68 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is a moderate elevation in the native myocardial T1-relaxation time at the basal inferior wall. There is, additionally, increased T2-signal, increased native T1-relaxation time, and early gadolinium enhancement of the RV free wall. This area, however, does not have evidence of late gadolinium enhancement. These findings could suggest the presence of an early inflammatory process. There is no myocardial iron overload.Left AtriumThe left atrium shows changes consistent with cardiac transplant. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 61%. The RVEDV is 211 ml (normal range 142+/-31), RV end diastolic volume index is 89 ml/m2 (normal range 82+/-16), the RVESV is 83 ml (normal range 54+/-17), and the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet, 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 a mild, eccentric jet of 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. Left upper pulmonary veins form a common confluence with left lower pulmonary veins before draining 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 FindingsThere is a mass (4.5cm x 3.3cm) around the first sternal wire of unclear etiology. 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 with normal systolic function (LVEF 66%). There is a moderate increase in native myocardial T1-relaxation time along the basal inferior wall, which could be due to subtle inflammation, fibrosis or infiltration. The T1 time throughout the rest of the myocardium is within normal limits. There is additionally no late gadolinium enhancement in the left ventricle. 2.The right ventricle is mildly dilated with normal systolic function (RVEF 61%). The free wall of the RV has evidence of increased T2-signal, increased T1-times, and early gadolinium enhancement. There is no late gadolinium enhancement in the RV free wall. These findings might be seen during the early phases of inflammation. 3.There is a mass (4.5cm x 3.3cm) around the first sternal wire of unclear etiology. Consider dedicated imaging if finding not explained by physical exam. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.