70 year old male with a history of coronary artery disease, mitral stenosis, aortic insufficiency, status post CABG, status post placement of mechanical mitral and aortic valves. Referred for evaluation of scar tissue progression for planning prior to possible insertion of device. Left VentricleThe interventricular septum has a sigmoid appearance. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 93 ml/m2 (normal range: 74+/-15), the LVEDV is 189 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 85 ml (normal range 47+/-19). There is late gadolinium enhancement in the an epicardial band in the basal inferior and inferoseptal walls. The pattern of late gadolinium enhancement is atypical for prior myocardial infarction and amyloidosis, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The amount of late gadolinium enhancement is mildly improved when compared to prior cardiac MRI images done 8/26/2014. There is delayed enhancement at the RV point, in a pattern typical for PA HTN. There is no evidence of myocardial iron overload. The differential diagnosis of these findings include, infiltrative disorders such as cardiac sarcoidosis, and prior myocarditis. Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 116 ml/m2 (normal range 82+/-16), the RVEDV is 237 ml (normal range 142+/-31), the RV end systolic volume index is 59 ml/m2 (normal range 31+/-9), and the RVESV is 119 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveA prosthetic mechanical aortic valve is noted. Mitral ValveA prosthetic mechanical mitral valve is noted. Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are a small number of subcarinal lymph nodes noted. 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. Normal left ventricular size and systolic function (LVEF 55%). 2. There is presence of patient motion in the LGE images, contributing to difficultly with interpretation. There is late gadolinium enhancement in the basal inferior and inferoseptal walls. The pattern of late gadolinium enhancement is atypical for prior myocardial infarction and amyloidosis, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The amount of late gadolinium enhancement is mildly improved when compared to prior cardiac MRI images done 8/26/2014. 3. There is delayed enhancement at the RV insertion point, in a pattern typical for PA HTN.4. Normal RV size and systolic function (RVEF 50%).5. Mechanical aortic and mitral valves noted.6. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.