86 year old man with history of dual chamber pacemaker for sick sinus syndrome, recent worsening atrial fibrillation burden, who presents for pre-ablation cardiac MRI. Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 111 ml (normal range 142+/-34), the LV end systolic volume index is 44 ml/m2 (normal range 25+/-9), the LVESV is 69 ml (normal range 47+/-19), the LV mass index is 34 g/m2 (normal range 85+/-15), and the LV mass is 55 g (normal range 164+/-36). There is global hypokinesis and dyssynchrony of the interventricular septum. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mild-moderately reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 160 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 90 ml (normal range 54+/-17). There is a pacemaker lead in the right ventricle.Right AtriumThe right atrium is severely dilated. There is a pacemaker lead which terminates in the right atrial appendage. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve leaflet tips are thickened. The valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The ascending aorta measured 39 x 41mm.Pulmonary VeinsAll five pulmonary veins drain normally into the left atrium.The pulmonary vein dimensions are as follows:RLPV: 14 x 16mmRUPV: 17 x 21mmRMPV: 11 x 10mmLLPV: 18 x 18mmLUPV: 12 x 17mmPulmonary ArteryArtifact from the pacemaker overlies the main pulmonary artery. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. Pacemaker leads are visualized in the SVC.PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsThere are small bilateral pleural effusions. There are multiple well circumscribed nonenhancing lesions on the kidneys bilaterally; most likely represent cysts. 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. The left ventricle is normal in size with moderately reduced systolic function (37%).2. The right ventricle is normal in size with mild-moderately reduced systolic function (44%). 3. Severe right atrial dilation. 4. Pulmonary vein anatomy and dimensions as noted above. 5. Pacemaker leads visualized in the right atrium and ventricle. 6. At least moderate tricuspid regurgitation. 7. See extracardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.