45 year old female with a history of COPD on oxygen, pulmonary hypertension, pulmonary sarcoidosis, found to have dilated aortic root with moderate-severe aortic regurgitation on echocardiography. Left VentricleThe left ventricle is moderately dilated with low normal systolic. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 106 ml/m2 (normal range: 65+/-11), the LVEDV is 179 ml (normal range 109+/-23), the LV end systolic volume index is 49 ml/m2 (normal range 18+/-5), the LVESV is 83 ml (normal range 31+/-10), the LV mass index is 59 g/m2 (normal range 67+/-11), and the LV mass is 99 g (normal range 114+/-24). 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 though the images were difficult to interpret due to significant breathing artifact (patient unable to perform adequate breath holds). Pre-contrast native T1 mapping time = 1108 msLeft AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 32%, the RV end diastolic volume index is 94 ml/m2 (normal range 69+/-14), the RVEDV is 158 ml (normal range 110+/-24), the RV end systolic volume index is 64 ml/m2 (normal range 22+/-8), and the RVESV is 108 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve is tri-leaflet. There is thickening of the aortic valve leaflets. There is at least mild-moderate aortic regurgitation based on quantitative QFlow analysis (regurgitant fraction 20%) however this is likely underestimated based on qualitative assessment. Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild to moderate 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. Measurements made from 3D whole heart study which was of marginal quality.Aorta measurements:Sinus of Valsalva: 45x45x43 mm.Sinotubular Junction: 39x38 mm.Proximal Ascending Aorta: 45x41 mmAscending Aorta (immediately proximal to innominate artery): 38x40 mmAscending Aorta (immediately distal to innominate artery): 22x24 mmDescending Aorta: 22x23 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated (57x53 mm). Left PA 25x24 mm, right PA 26x27 mmVenous 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 moderately dilated with low normal systolic. The overall LV ejection fraction is 54%.2. The right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 32%3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 4. There is at least moderate-severe aortic regurgitation by quantitative analysis but this is likely underestimated based on visual interpretation which suggests moderate-severe aortic regurgitation. The stroke volume difference between the right and left heart (LV = 96 mL and RV = 50 mL also suggests moderate to severe aortic regurgitation.5. Dilated aortic root and ascending aorta with above measurements. 6. Dilated main PA with above measurements.7. Suggest repeat study to re-assess in 3-6 months or whenever clinically appropriate. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.