52 year-old male with a history of atrial fibrillation with three previous ablations and recent cardioversion with recurrence of atrial fibrillation. He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 66 ml/m2 (normal range: 74+/-15), the LVEDV is 164 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 86 ml (normal range 47+/-19), the LV mass index is 25 g/m2 (normal range 85+/-15), and the LV mass is 59 g (normal range 164+/-36). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely dilated (end-systolic volume 142 ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVEDV is 174 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 84 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.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.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. The ostial measurements are as below. All of the pulmonary vein ostial had evidence of late gadolinium enhancement secondary to ablation; however, the left upper pulmonary vein appears to have the largest "ablation gaps."LUPV: 15x14mmLIPV: 14x9mmRUPV: 21x16mmRIPV: 17x13mmPulmonary 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 normal in size with mildly reduced systolic function (LVEF 48%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. The right ventricle is normal in size and systolic function (RVEF 52%).3. The left and right atria are severely dilated. 4. The left inferior pulmonary vein diameter is somewhat small.5. The left upper pulmonary vein appears to have the largest "ablation gap."I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.