64 y ear old male with history of ischemic cardiomyopathy, diabetes and atrial fibrillation presenting prior to planned AF ablation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 47%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 174 ml (normal range 142+/-34), the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9), the LVESV is 93 ml (normal range 47+/-19), the LV mass index is 62 g/m2 (normal range 85+/-15), and the LV mass is 114 g (normal range 164+/-36). The LV dysfunction is global with regional variation . There is are two distinct transmural myocardial infarctions. The first involves the mid anterior and anterolateral walls and the apical anterior, lateral, and inferior walls. The second involving the entire inferior wall and the basal inferolateral wall. No LV thrombus seen. Left AtriumThe left atrium is mildly dilated (93ml). The interatrial septum is aneurysmal.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVEDV is 120 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 52 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.AortaThere is a left sided aortic arch with a "pseudo-bovine" brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. A right middle pulmonary vein is noted. Pulmonary vein ostia are as below: LUPV: 17x21mmLIPV: 17x13mmRUPV 19x\18mmRMPV: 10x11mmRLPV: 17x12mmPulmonary 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 FindingsSternotomy wires and bypass graft clips present. 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 with mildly reduced systolic function (LVEF 47%).2. Two large transmural myocardial infarctions are noted in the usual territory of the left anterior descending artery and the right coronary artery.3. Normal RV size and systolic function (RVEF 57%).4. Mild left atrial dilation with aneurysmal interatrial septum.5. Normal pulmonary vein anatomy. A small right middle pulmonary vein is additionally noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.