A 57 year old male with atrial flutter and suspected hypertrophic cardiomyopathy by echocardiography referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size with hyperdynamic performance. The mass is severely increased. There is excentric hypertrophy while the maximal thickness was noted at the infero- septum (24mm). The overall LV ejection fraction is 68%, the LV end diastolic volume index is 102 ml/m2 (normal range: 74+/-15), the LVEDV is 232 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 75 ml (normal range 47+/-19), the LV mass index is 141 g/m2 (normal range 85+/-15), and the LV mass is 321 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is extensive late gadolinium enhancement involving the entire apex transmurally, and in a patchy pattern at the base and middle segments of all the walls (septum, lateral, inferolateral, inferior and anterior) but predominantly at the septum. The pattern is atypical for myocardial infarction and correlates with the diagnosis of hypertrophic cardiomyopathy. There is no iron overload. No findings supporting cardiac amyloidosis.No intracardiac thrombus.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with hyperdynamic performance. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 104 ml/m2 (normal range 82+/-16), the RVEDV is 237 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 83 ml (normal range 54+/-17). The was is mildly thickened with enhancement.Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation. There is no stenosis. Accelerated flow was noted through the valve. There is no systolic anterior movement phenomenon.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. No systolic anterior motion of the anterior leaflet of the mitral valve.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 mildly dilated.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 pericardial effusion.
1. The left ventricle is normal in size with hyperdynamic contractility; the LVEF is 68%. The mass is severely increased with eccentric hypertrophy. Maximal thickness at the infero- septum (24mm). Extensive enhancement involving the entire apex transmurally, and in a patchy pattern at the base and middle segments of all the walls (septum, lateral, inferolateral, inferior and anterior) but predominantly at the septum. Enhancement is also noted at the RV insertion at septum. No SAM or MR. 2. The right ventricle is normal in size with hyperdynamic performance, the RVEF is 65%. Mild thickening with enhancement. These findings suggest hypertrophic cardiomyopathy with biventricular involvement.3. The nonstenotic, trileaflet aortic valve opens widely, mild aortic regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.