75 year old male with a history of scimitar syndrome, repaired in the 1970s, and persistent atrial fibrillation which is not responsive to medication. Referred for cardiovascular MRI to evaluate pulmonary veins and for atrial fibrosis. Situs and Cardiac PositionThere is cardiac situs solitus, with dextro-position, and anterior orientation of the apex. Abdominal situs is normal.Left VentricleThe left ventricle is normal in size and low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 158 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 46 g/m2 (normal range 85+/-15), and the LV mass is 104 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.Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 171 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 90 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly enlarged.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. The descending aorta is tortuous.Pulmonary VeinsThe left upper and left lower pulmonary veins drain normally to the left atrium. The right pulmonary veins are tortuous and drain through a single ostium to the left atrium. There is no obvious evidence of late gadolinium enhancement in the left atrial wall. Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium. IVC is dilated.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a small right pleural effusion. 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. There is cardiac situs solitus, with dextro-position, and anterior orientation of the apex. Abdominal situs is normal2. Right pulmonary veins are tortuous and drain through a single orifice to the left atrium. Left pulmonary veins drain normally to the left atrium.3. There is no obvious evidence of late gadolinium enhancement of the left atrial wall.4. Left ventricle is normal in size with low-normal systolic function (LVEF 54%)5. Right ventricle is normal in size with mildly reduced systolic function (RVEF 48%)6. There is a small right pleural effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.