67 yo M with HCV, cirrhosis, RVOT PVCs, enlarged RV, chest pain, intermediate CAD. Referred for cardiac stress MRI prior to liver transplant and possible hernia repair. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 68%. The LVEDV is 131 ml (normal range 142+/-34), the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVESV is 42 ml (normal range 47+/-19) and the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9). The LV mass is 82 g (normal range 164+/-36) and the LV mass index is 46 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. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 67%. The RVEDV is 125 ml (normal range 142+/-31), RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVESV is 41 ml (normal range 54+/-17), and the RV end systolic volume index is 23 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. There is mild thickening of the tip of the anterior mitral leaflet.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 is normal in size and drains normally into the right atrium. There is a prominent azygous vein which appears dilated and tortuous consistent with the patient's underlying liver disease.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is at least a moderate sized hiatal hernia. 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.No perfusion defects/ "ischemia" present during hyperemia.2.No late gadolinium enhancement. No prior myocardial infarction. The entire myocardium is viable.3.Normal LV size and systolic function (LVEF 68%). No regional wall motion abnormalities.4.Normal RV size and systolic function (RVEF 67%)5.There is a prominent azygous vein which appears dilated and tortuous consistent with the patient's underlying liver disease.6.See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.