A 40 years old male with past history of syncope years ago, palpitations with PVCs on holter and transesophageal echocardiography in 2013 with normal left and right ventricular size and function, significantly enlarged left and right atrial volumes with no evidence of shunt. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 204 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 78 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 120 g (normal range 164+/-36). 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. No VSD noted. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 200 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 79 ml (normal range 54+/-17).AtriaThe left atrium is severely dilated (168ml). The right atrium is severely dilated (151ml). No evidence of inter-atrial shunt based on anatomic visualization, first pass contrast imaging, and normal Qp/Qs (1.03).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 normal in size.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. Normal LV size and systolic function (LVEF 62%) without underlying myocardial fibrosis, infiltration, inflammation.2. Normal RV size and systolic function (RVEF 61%).3. Severe biatrial dilation.4. No evidence of intra-cardiac shunt. Normal pulmonary venous drainage.