A 53 year old female with personal history of hypertension, left ventricular outflow tract obstruction and dyspnea on exertion. A recent echocardiography study showed normal systolic function with increased LVOT gradient but signal related to mitral regurgitation was not ruled out. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. There is asymmetric hypertrophy of the interventricular septum (maximum IVSd is 15mm and PWd is 8mm). There is additionally evidence of a focal contact lesion on the interventricular septum likely secondary to repetitive contact between the interventricular septum and the anterior mitral leaflet during systolic anterior motion of the anterior mitral leaflet. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 69 ml/m2 (normal range: 65+/-11), the LVEDV is 134 ml (normal range 109+/-23), the LV end systolic volume index is 29 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 59 g/m2 (normal range 67+/-11), and the LV mass is 114 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 focal replacement fibrosing, infiltrative, or inflammatory process.Native myocardial T1-times were globally mildly increased (range between 1090 to 1110ms), suggesting the presence of interstitial myocardial fibrosis.No myocardial iron overload was noted.No intracavitary thrombus was noted.Left AtriumThe left atrium is mildly dilated. The LA volume is 105 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 48 ml/m2 (normal range 69+/-14), the RVEDV is 93 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 41 ml (normal range 35+/-13).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet and opens widely. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate to severe mitral regurgitation. There is evidence of systolic anterior motion of the mitral leaflet. Additionally, the anterior leaflet is thickened and somewhat calcified. 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. A "pseudo-bovine" pattern was noted (normal variant). 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 FindingsSee lung findings on recent chest CT. 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 LV size with normal systolic function (LVEF 58%) without evidence of late gadolinium enhancement but with mildly elevated native myocardial T1 times suggesting the presence of mild interstitial fibrosis.2. There is asymmetric hypertrophy of the interventricular septum associated with systolic anterior motion of the mitral valve leaflets causing a focal contact lesion on the interventricular septum, moderate flow acceleration in the left ventricular outflow tract, and moderate to severe mitral regurgitation. The maximum thickness of the interventricular septum is 15mm; where as, the posterior wall thickness is approximately 8mm. Given these findings, the diagnosis of hypertrophic cardiomyopathy should be considered. 3. Trileaflet aortic valve without evidence of aortic valve stenosis. 4. Normal RV size and systolic function (RVEF 55%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.