86 year old man with LV dysfunction referred to assess for viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 18%, the LV end diastolic volume index is 141 ml/m2 (normal range: 74+/-15), the LVEDV is 265 ml (normal range 142+/-34), the LV end systolic volume index is 116 ml/m2 (normal range 25+/-9), the LVESV is 217 ml (normal range 47+/-19), the LV mass index is 63 g/m2 (normal range 85+/-15), and the LV mass is 118 g (normal range 164+/-36). There left ventricular systolic dysfunction is global with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No left ventricular thrombus is seen. No evidence of myocardial iron overload.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 29%, the RV end diastolic volume index is 113 ml/m2 (normal range 82+/-16), the RVEDV is 211 ml (normal range 142+/-31), the RV end systolic volume index is 80 ml/m2 (normal range 31+/-9), and the RVESV is 149 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. There is mild to moderate atherosclerosis of the aortic arch.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary 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 a small pericardial effusion.Extracardiac FindingsThere are bilateral pleural effusions, left greater than right. 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. Severe LV dilation with severely reduced systolic function (LVEF18%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. No evidence of prior myocardial infarction. Most of the LV is likely to be viable.2. Normal RV size with severely reduced systolic function (RVEF 29%).3. Severe left atrial dilation.4. Moderate right atrial dilation.5. Mild to moderate atherosclerosis of the aortic arch.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.