66 year old male with prior MI and abnormal perfusion on nuclear imaging, assess for myocardial viabilityMEDICATIONS: Aspirin, carvedilol, HCTZ, rosuvastatin Viability/ Myocardial ScarThere is a non-transmural myocardial infarction involving the basal anterolateral wall, the basal and mid inferolateral wall, and the apical inferior wall. Based on late gadolinium enhancement, these segments have an intermediate probability of viability. However, after the administration of dobutamine, most of the segments demonstrate increased contractility suggesting that they are indeed viable. The remainder of the myocardium is free of myocardial infarction and viable. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 106 ml/m2 (normal range: 74+/-15), the LVEDV is 219 ml (normal range 142+/-34), the LV end systolic volume index is 58 ml/m2 (normal range 25+/-9), the LVESV is 120 ml (normal range 47+/-19), the LV mass index is 80 g/m2, and the LV mass is 165 g. There is hypokinesis in the basal and mid inferolateral wall of the myocardium. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 196 ml (normal range 142+/-31), the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9), and the RVESV is 95 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 no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. 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 are normal in size and 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 non-transmural myocardial infarction involving the basal anterolateral wall, the basal and mid inferolateral wall, and the apical inferior wall. Based on late gadolinium enhancement, these segments have an intermediate probability of viability. However, after the administration of dobutamine, most of the segments demonstrate increased contractility suggesting that they are indeed viable. The remainder of the myocardium is free of myocardial infarction and viable. 2. Mild left ventricular dilation with mildly reduced systolic function (LVEF 45%).3. Normal RV size and systolic function (RVEF 52%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.