A 40 year old male with Crohn's disease, s/p collectomy, atrial flutter after ablation and after cardiac arrest post-cardioversion. Now presents with new onset biventricular heart failure and referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with moderate to severely reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 97 ml/m2 (normal range: 74+/-15), the LVEDV is 255 ml (normal range 142+/-34), the LV end systolic volume index is 66 ml/m2 (normal range 25+/-9), the LVESV is 165 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 138 g (normal range 164+/-36). There is hypokinesis of the entire septum and inferior wall at the base, middle and apical segments, there is hypokinesis of the anterior wall at the middle and apical segments. There is late gadolinium enhancement sparing the endocardium in the entire septum and inferior wall at the base, middle and apical segments, and in the anterior wall at the middle and apical segments. These findings suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process and are atypical for myocardial infarction. The T1-mapping times are normal.There is no myocardial iron overload.There is no intracavitary thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 27%, the RV end diastolic volume index is 108 ml/m2 (normal range 82+/-16), the RVEDV is 271 ml (normal range 142+/-31), the RV end systolic volume index is 79 ml/m2 (normal range 31+/-9), and the RVESV is 199 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.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 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 mildly dilated.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. The left ventricle is normal in size with moderate to severely reduced systolic function, the LVEF is 36%, though this has improved since previous study. There is hypokinesis of the entire septum and inferior wall at the base, middle and apical segments, there is hypokinesis of the anterior wall at the middle and apical segments. 2. There is late gadolinium enhancement sparing the endocardium in the entire septum and inferior wall at the base, middle and apical segments, and in the anterior wall at the middle and apical segments, similar in distribution to previous study. These findings suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process and are atypical for myocardial infarction. The T1-mapping times are normal. There is no myocardial iron overload. There is no intracavitary thrombus.3. The right ventricle is normal in size with severely reduced systolic function, the RVEF is 27%, though improved from previous study. 4. The right atrium is mildly dilated, improved from previous study.5. The main pulmonary artery is mildly dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.