Coronary artery disease, assess for viability, three-vessel CAD, body surface area equals 2.4 sq m2 Left VentricleThe left ventricle is moderately enlarged. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 111.7 ml/m2 (normal range: 74+/-15), the LVEDV is 268 ml (normal range 142+/-34), the LV end systolic volume index is 60 ml/m2 (normal range 25+/-9), the LVESV is 144 ml (normal range 47+/-19. There are no regional wall motion abnormalities present. There is enhancement involving the inferior and inferolateral walls, extending from the base to nearly the apex, sparing the extreme base and apex. This is compatible with a myocardial infarct in the circumflex coronary artery territory. The basilar component of this infarct is extensive, approximately 80% wall thickness, involving the inferolateral wall and the inferior walls. As it approaches the mid chamber, this becomes transmural. At this location, there is a sessile thrombus that lines the subendocardial infarct (series 2/1/2001 image 23), measuring a maximum of 3 mm thickness. The apical component of the infarct is isolated to the infero-lateral wall.There is akinesia demonstrated by the basal one quarter of the inferior wall and basal one half of the lateral wall. Severe hypokinesia is demonstrated by the basal half of the interventricular septum. The majority of the anterior wall is moderately hypokinetic. Normal contractility is demonstrated by the remaining segments.The anterolateral, anterior, mid and apical inferior walls and entire septum are viable. These findings were discussed over the phone with the resident caring for the patient at 5:00 PM on 6/15/2015.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 81.7 ml/m2 (normal range 82+/-16), the RVEDV is 183 ml (normal range 142+/-31), the RV end systolic volume index is 30.8 ml/m2 (normal range 31+/-9), and the RVESV is 69 ml (normal range 54+/-17). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely. There is no significant dephasing inferior to the aortic valve to suggest significant aortic regurgitation. Dedicated through plane imaging of the aortic valve was not performed.Mitral ValveThe mitral valve opens widely. There is mitral regurgitation, not quantified. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.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 no pericardial thickening or effusion.
1. There is a myocardial infarct in the circumflex coronary arterial territory, extending from nearly the base to the apex. This involves the inferolateral and inferior walls at the base, where it involves 80% wall thickness. The infarct becomes transmural at the mid chamber and extends to the apical lateral wall. 2. Localized, sessile thrombus measuring 3 mm in thickness lines the subendocardium adjacent to the infarct at the mid lateral wall.3. Left ventricular ejection fraction equals 46%.