69 year old female with aortic stenosis referred to assess for viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. There is severe hypokinesis of the basal inferior, inferoseptum, and inferolateral walls; there is hypokinesis of the mid inferior and inferolateral walls; there is hypokinesis of the apical lateral wall. The overall LV ejection fraction is 23%, the LV end diastolic volume index is 149 ml/m2 (normal range: 65+/-11), the LVEDV is 286 ml (normal range 109+/-23), the LV end systolic volume index is 115 ml/m2 (normal range 18+/-5), the LVESV is 222 ml (normal range 31+/-10), the LV mass index is 107 g/m2 (normal range 67+/-11), and the LV mass is 206 g (normal range 114+/-24). There are small transmural myocardial infarctions involving the apical anterior, inferior, and lateral walls. These small segments are unlikely to be viable. The remainder of the left ventricle is free of myocardial infarction and there is a large amount of myocardial viability.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 122 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet and significantly calcified. There is significant flow acceleration suggesting at least moderate aortic valve stenosis, correlation with echo to quantify severity suggested. There is mild aortic regurgitation. Mitral ValveThe mitral valve opens widely. There is tethering of the posterior leaflet with mild 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.AortaThere is a left sided aortic arch with a pseudo-bovine brachiocephalic branching pattern. The aortic root is normal in size. The descending aorta has mild to moderate diffuse atherosclerosis. There is a small infra-renal aneurysm (26mm) with significant atheroma.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. Severe LV dilation with severely reduced systolic function (LVEF 23%). There is a large wall motion abnormality as described above.2. Small, transmural, myocardial infarctions are present in the apical anterior, lateral, and inferior walls.These small segments are not likely to be viable. The remainder of the myocardium is free of myocardial infarction and there is an overall large burden of myocardial viability.3. Normal RV size and systolic function (RVEF 51%).4. Severe left atrial dilation. 5. At least moderate aortic valve stenosis, correlation with echocardiography for better quantification of aortic valve stenosis suggested.6. Posterior leaflet of mitral valve is restricted with evidence of mild mitral regurgitation. 7. The descending aorta has mild to moderate diffuse atherosclerosis. There is a small infra-renal aneurysm (26mm) with significant atheroma.