52 year old man with history of CAD s/p CABG and PCI, with recent cardiac catheterization demonstrating a chronic total occlusion of the 1st obtuse marginal branch. He is referred for cardiac MRI to evaluate myocardial viability. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 93 ml/m2 (normal range: 74+/-15), the LVEDV is 210 ml (normal range 142+/-34), the LV end systolic volume index is 41 ml/m2 (normal range 25+/-9), the LVESV is 93 ml (normal range 47+/-19). There is increased wall thickness (12-13mm) consistent with left ventricular hypertrophy. There is hypokinesis of the basal to mid inferior and basal inferoseptal wall. There is subendocardial late gadolinium enhancement in the mid inferior and inferoseptal wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, suggestive of intermediate viability. The remainder of the myocardium is viable. There is no evidence of myocardial iron overload. ECV is calculated at 27%, which is within normal limits. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 107 ml/m2 (normal range 82+/-16), the RVEDV is 241 ml (normal range 142+/-31), the RV end systolic volume index is 54 ml/m2 (normal range 31+/-9), and the RVESV is 121 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly 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 trivial tricuspid regurgitation.AortaThere is a left sided aortic archs with a normal brachiocephalic branching pattern. The aortic root is normal in size.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 and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternotomy wires are present. There is artifact in the AV groove which may be related to his coronary stents. 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. Normal LV size and function (EF 55%). There is hypokinesis of the basal to mid inferior and basal inferoseptal wall. 2. Mild left ventricular hypertrophy. 3. There is subendocardial late gadolinium enhancement in the mid inferior and inferoseptal wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, suggestive of intermediate viability. The remainder of the myocardium is viable.4. Normal size RV with normal systolic function (EF 50%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.