67 year old man with history of ischemic cardiomyopathy s/p CABG, LV aneurysm and mitral valve repair and atrial fibrillation with dual chamber ICD referred for cardiac MRI to evaluate for scar burden. Left VentricleThere is severe LV dysfunction. There is thinning of the basal to mid lateral, inferolateral and inferior wall with associated akinesis of these segments. The apex was not visualized due to significant artifact. There was late gadolinium enhancement in the basal to mid lateral, inferolateral and inferior walls which was transmural. This territory is not viable. The presence of late gadolinium enhancement in the apical segments could not be evaluated. Right Ventricle:There is an ICD lead in the right ventricle. The RV is not well visualized.Left Atrium: Severely dilated.Mitral ValveMorphology is consistent with history of repair. There is mitral regurgitation, but quantification on this study was not possible.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Extracardiac FindingsThere is a left chest wall defibrillator with significant associated artifact. There are sternotomy wires 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. Severe LV dysfunction. The basal to mid lateral, inferolateral and inferior walls are thinned and akinetic. There is transmural late gadolinium enhancement seen in these segments, which suggests no viability. 2. The apical segments could not be visualized to evaluate wall function or late enhancement.3. Severe left atrial dilation. 4. Mitral valve morphology consistent with history of repair. 5. There is significant artifact present due to the patient's indwelling cardiac device. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.