52Yrs old male with hx of multiple MI; LV dysfunction, admitted for NSTEMI/Chronic Systolic Heart Failure. Referred for cardiac MRI for assessment of viability and ascending aorta aneurysm. Left VentricleThe left ventricle is severely dilated with severely depressed systolic function. The overall LV ejection fraction is 19%. The LVEDV is 348 ml (normal range 142+/-34), the LV end diastolic volume index is 155 ml/m2 (normal range: 74+/-15), the LVESV is 281 ml (normal range 47+/-19) and the LV end systolic volume index is 125 ml/m2 (normal range 25+/-9). The LV mass is 131 g (normal range 164+/-36) and the LV mass index is 58 g/m2 (normal range 85+/-15). The left ventricular function is globally depressed with thinning and severe hypokinesia of the basal to apical inferior and inferoseptal walls. There is non-transmural (50 - 75% thickness) subendocardial late gadolinium enhancement along the basal to apical inferior and inferoseptal walls in the vascular territory of the right coronary artery, indicative of myocardial infarction with intermediate viability. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 20%. The RVEDV is 200 ml (normal range 142+/-31), RV end diastolic volume index is 89 ml/m2 (normal range 82+/-16), the RVESV is 161 ml (normal range 54+/-17), and the RV end systolic volume index is 71 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is moderate central aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial to mild tricuspid regurgitation.AortaThere is a left sided aortic arch with normal branching pattern of the supraaortic branches. The aortic root and sinotubular junction are normal in caliber. There is a fusiform aneurysm of the ascending aorta that measures approximately 49 mm. Tortuous ectatic aortic arch. The descending thoracic aorta is normal in caliber. 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 FindingsThere are signs of residual interstitial pulmonary edema, improved from prior studies. Bilateral lower lobe subsegmental atelectasis. Abnormal focal hyperintense area in the superior segment of the right lower lobe likely represents small amount of alveolar edema. Small left pleural effusion. 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. Globally depressed left ventricular systolic function (LVEF 19%). Regional wall motion abnormality of the basal to apical inferior and inferoseptal walls.2. Non transmural (50 - 75%) sub endocardial late gadolinium enhancement of the basal to apical inferior and inferoseptal walls consistent with myocardial infarction in the right coronary artery territory; the involved myocardium has intermediate viability. 3. Fusiform aneurysm of the tubular ascending aorta, sparing the sinotubular junction and stable from prior study (49 mm). No signs of acute complication. 4. Moderate central aortic regurgitation. Mild mitral and tricuspid regurgitation. 5. Residual interstitial pulmonary edema and small left pleural effusion. 