59M w/ no significant PMHx presenting with SOB and evaluation for CABG and aortic valve replacement. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 34%. The LVEDV is 475 ml (normal range 142+/-34), the LV end diastolic volume index is 215 ml/m2 (normal range: 74+/-15), the LVESV is 313 ml (normal range 47+/-19) and the LV end systolic volume index is 142 ml/m2 (normal range 25+/-9). The LV mass is 159 g (normal range 164+/-36) and the LV mass index is 72 g/m2 (normal range 85+/-15). There is akinesis of the inferior and severe hypokinesis of the inferoseptum from base to LV apex. There is transmural late gadolinium enhancement in the inferior and inferospetal walls. These areas are likely not viable. There is also subendocardial late gadolinium enhancement in the basal posterior wall. This area is of intermediate viability. This pattern of late gadolinium enhancement is consistent with prior myocardial infarction. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 41%. The RVEDV is 244 ml (normal range 142+/-31), RV end diastolic volume index is 110 ml/m2 (normal range 82+/-16), the RVESV is 143 ml (normal range 54+/-17), and the RV end systolic volume index is 65 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThere is calcification of the aortic valve leaflets. The aortic valve is functionally bicuspid with likely fusion of the right and non coronary cusps. Qflow measurement was limited by patient's frequent PVCs. Regurgitant volume (Qflow method = 53%). Using ventricular stroke volume, regurgitant fraction was 38%. Taking these finding into account, there is at least moderate aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. The mitral valve leaflets appear thickened.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.Ao sinus of valsalva = 41 x 41 x 41 mmAo sinotubular junction = 35 x 34 mmAscending aorta pre-branching = 37 x 38 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC 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 LV is severely dilated with moderately reduced systolic function (LVEF 34%)2.There is akinesis of the inferior and severe hypokinesis of the inferoseptum from base to LV apex. There is transmural late gadolinium enhancement in the inferior and inferoseptal walls. These areas are likely not viable. There is also subendocardial late gadolinium enhancement in the basal posterior wall. This area is of intermediate viability. This pattern of late gadolinium enhancement is consistent with prior myocardial infarction.3.The RV is normal in size with mildly reduced systolic function (RVEF 41%)4.Functionally bicuspid aortic valve. There is at least moderate aortic regurgitation, quantification limited by frequent PVCs.5.Aortic measurements as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.