A 57 year old male with personal history of coronary artery disease after multiple PCI's and coronary artery bypass graft surgery on 2/2016 (Lima to LAD, SVG to DG and SVG to OM). MEDICATIONS: amiodarone, amlodipine, aspirin, atorvastatin, lisinopril, metoprolol, mexiletine, prasugrel, ranexa First Pass PerfusionA perfusion defect was noted at the basal infero-septal and inferior walls. Viability/ Myocardial ScarThere is late gadolinium enhancement in more than 50% of the thickness of the wall at the basal inferior wall compatible with an old transmural myocardial infarction. This segment is not likely to be viable. The remainder of the left ventricle is free of myocardial infarction and likely to be viable. 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 75 ml/m2 (normal range: 74+/-15), the LVEDV is 191 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 98 ml (normal range 47+/-19), the LV mass index is 61 g/m2, and the LV mass is 157 g. There is hypokinesis of the basal to mid inferior wall. Left AtriumThe left atrium is normal in size (82ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 71 ml/m2 (normal range 82+/-16), the RVEDV is 181 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 76 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.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 mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. The ascending aorta is mildly dilated (40mm). There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 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. There is a transmural myocardial infarction involving the basal inferior wall with minimal peri-infarct ischemia. Most of the infarcted segment is not likely to be viable. The remainder of the myocardium is free of myocardial infarction or ischemia and is viable.2. Normal LV size with mildly reduced systolic function (LVEF 48%) with basal to mid inferior wall hypokinesis.3. Normal RV size and systolic function (RVEF 58%).4. Mild dilation of the ascending aorta. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.