53 year old with history of hypertension, diabetes, OSA, CKD and CHF presenting for evaluation of left ventricular size and function and to evaluate degree of aortic regurgitation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 19%, the LV end diastolic volume index is 180 ml/m2 (normal range: 65+/-11), the LVEDV is 395 ml (normal range 109+/-23), the LV end systolic volume index is 145 ml/m2 (normal range 18+/-5), the LVESV is 318 ml (normal range 31+/-10), the LV mass index is 94 g/m2 (normal range 67+/-11), and the LV mass is 206 g (normal range 114+/-24). The left ventricular dysfunction is global with regional variation. There is subendocardial (involving nearly 50% of the wall thickness) late gadolinium enhancement of the mid to basal inferior and inferolateral walls. The pattern is consistent with prior myocardial infarction. There is additionally a mid-wall stripe pattern of late gadolinium enhancement involving the basal to mid interventricular septum. This pattern suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No LV thrombus seen. Left AtriumThe left atrium is moderately 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 78 ml/m2 (normal range 69+/-14), the RVEDV is 171 ml (normal range 110+/-24), the RV end systolic volume index is 53 ml/m2 (normal range 22+/-8), and the RVESV is 116 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is moderate aortic regurgitation with calculated regurgitant fraction of 34%. Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root, arch and descending thoracic aorta are 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. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 19%.2. There is subendocardial (involving nearly 50% of the wall thickness) late gadolinium enhancement of the mid to basal inferior and inferolateral walls. The pattern is consistent with prior myocardial infarction. There is additionally a mid-wall stripe pattern of late gadolinium enhancement involving the basal to mid interventricular septum. This pattern suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 32%.4. The aortic valve is trileaflet, opens widely and there is moderate aortic regurgitation with calculated regurgitant fraction of 34%. 