63 year old man with history of recent heart transplant, with reduced cardiac output on right heart catheterization concerning for occult rejection, referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVEDV is 115 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 51 ml (normal range 47+/-19), the LV mass index is 83 g/m2 (normal range 85+/-15), and the LV mass is 130 g (normal range 164+/-36). The basal septum measures 11mm in thickness. There is no regional wall motion abnormality. There is a borderline area of patchy late gadolinium enhancement in the basal inferolateral wall, which is improved from before but may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1 time in the septum is 1048-1062ms, and 1133ms in the basal inferior wall (On previous study, native T1 time was reported as 1063ms in basal septum and 1150ms in basal inferior wall). Extracellular volume fraction is 27%, which is within normal limits. There is no evidence of significant edema on T2 STIR imaging. Due to artifact, T1 black blood imaging was nondiagnostic.Left AtriumThe left atrium is consistent with cardiac transplant. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 91 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 49 ml (normal range 54+/-17).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 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 bovine 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 and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternotomy wires are present. There is a right lower lobe consolidation versus mass which has increased in size from the previous study and does not enhance with contrast. Also, there may be a mass in the left hilum and a small nodule in the left upper lung. 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. The overall LV ejection fraction is 56%, which is improved from before. 2. There is a borderline area of patchy late gadolinium enhancement in the basal inferolateral wall, which is improved from before but may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, which is stable when compared to the previous study.4. See extra-cardiac findings.Findings discussed with Dr. Uriel.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.