36 year old man with cardiomyopathy referred for further evaluation. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 116 ml/m2 (normal range: 74+/-15), the LVEDV is 213 ml (normal range 142+/-34), the LV end systolic volume index is 60 ml/m2 (normal range 25+/-9), the LVESV is 109 ml (normal range 47+/-19). There is mild global hypokinesis present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function . The overall RV ejection fraction is 47%, the RV end diastolic volume index is 129 ml/m2 (normal range 82+/-16), the RVEDV is 235 ml (normal range 142+/-31), the RV end systolic volume index is 68 ml/m2 (normal range 31+/-9), and the RVESV is 124 ml (normal range 54+/-17). The heart is displaced into the left thorax by a narrow (in antero-posterior direction) chest cavity. The RV is externally compressed by the sternum but there is no evidence of flow turbulence through the tricuspid valve or RV cavity.Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. The anterior mitral leaflet is prolonged and thickened. There is bileaflet mitral valve prolapse associated with at least mild to moderate mitral regurgitation with a very posteriorly directed jet. 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. The thoracic aorta 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 trace pericardial effusion.Extracardiac FindingsThe sternum is flattened but does not meet criteria for pectus excavatum. The minimal anterior posterior dimension of the chest is 5cm causing the heart to be displaced into the left thorax. 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. Mild LV dilation with mildly reduced systolic function (LVEF 49%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Mild RV dilation with mildly reduced systolic function (RVEF 47%). The RV is externally compressed by the sternum but there is no flow acceleration to suggest that the external compression is causing a hemodynamic problem.3. There is bileaflet mitral valve prolapse with evidence of at least mild to moderate mitral regurgitation.4. Thoracic aorta is normal in size. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.