49 year old African-American female with hypertension, venous thrombo-embolic disease with known anti-phospholipid antibody syndrome and newly diagnosed diffuse large b-cell lymphoma presenting for pre-chemotherapy cardiac evaluation. Left VentricleThe left ventricle is moderately enlarged with mildly reduced systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 115 ml/m2 (normal range: 65+/-11), the LVEDV is 234 ml (normal range 109+/-23), the LV end systolic volume index is 58 ml/m2 (normal range 18+/-5), the LVESV is 117 ml (normal range 31+/-10), the LV mass index is 55 g/m2 (normal range 67+/-11). There is basal infero-lateral akinesis with myocardial thinning. The lateral apex appears thin. There is transmural late gadolinium enhancement at the basal infero-lateral wall in a pattern consistent with coronary artery disease. The remaining myocardium is viable. There is no left ventricular thrombus. Left AtriumThe left atrium is severely enlarged. No obvious ASD or PFO on first pass perfusion imaging. Right VentricleThe right ventricle is severely enlarged with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 183 ml/m2 (normal range 69+/-14), the RVEDV is 371 ml (normal range 110+/-24), the RV end systolic volume index is 99 ml/m2 (normal range 22+/-8), and the RVESV is 202 ml (normal range 35+/-13). Right AtriumThe right atrium is severely enlarged. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is severe 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 severely enlarged (main PA 46 mm) while the right and left PA branches are normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. The IVC is enlarged. 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 enlarged with mildly reduced systolic function (LVEF 50%). There is basal infero-lateral akinesis with myocardial thinning with transmural late gadolinium enhancement in a pattern consistent with coronary artery disease. The remaining myocardium is viable. 2. The right ventricle is severely enlarged with mildly reduced systolic function (RVEF 45%)3. There is severe tricuspid regurgitation and at least moderate mitral regurgitation. 4. There is severe dilation of the main pulmonary artery (MPA 46 mm). 5. Severe biatrial enlargementI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.