A 78 year old female with hypertension, atrial fibrillation and suspected hypertrophic cardiomyopathy. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 58 ml/m2 (normal range: 65+/-11), the LVEDV is 96 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 43 ml (normal range 31+/-10), the LV mass index is 45 g/m2 (normal range 67+/-11), and the LV mass is 74 g (normal range 114+/-24). There is focal hypertrophy of the basal antero-septum (dimension 13mm) and the remainder of the myocardium has normal wall thickness (~9mm). Based on myocardial tagging, the basal septum has somewhat reduced myocardial deformation. The deformation is normal in the remainder of the myocardium. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracavitary thrombus was seen.No myocardial iron overload was seen.Left AtriumThe left atrium is severely dilated. The LA volume is 220 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 56 ml/m2 (normal range 69+/-14), the RVEDV is 92 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 42 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate to severe mitral regurgitation. The anterior mitral leaflet is thickened and somewhat calcified. No systolic anterior motion of the mitral leaflets is noted. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate to severe 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 mildly dilated (31 x 32mm). 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. Normal left ventricular size and systolic function (LVEF 55%). The basal septum is mildly hypertrophied and has a mild reduction in intramyocardial deformation. The remainder of the myocardium has normal wall thickness and normal deformation. There is no evidence of underlying myocardial fibrosis, inflammation, or infiltration. Strictly speaking, the diagnostic criteria for hypertrophic cardiomyopathy are not met on this study suggesting that the hypertrophy involving the basal septum may be secondary to a sigmoid septum rather than hypertrophic cardiomyopathy. Repeat imaging to assess for change in septal wall thickness may be helpful to differentiate hypertrophic cardiomyopathy from a sigmoid septum. If the diagnosis of hypertrophic cardiomyopathy has been confirmed by other means, then from a cardiac MRI perspective, the absence of late gadolinium enhancement is considered a low risk marker for significant arrhythmia.2. Normal RV size and systolic function (RVEF 54%). 3. Severe biatrial dilation.4. At least moderate to severe mitral and tricuspid valve regurgitation .I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.