44 year old man with recent diagnosis of severe multivessel CAD, bicuspid aortic valve and reduced ejection fraction who was referred for cardiac MRI to evaluate for viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 256 ml/m2 (normal range: 74+/-15), the LVEDV is 465 ml (normal range 142+/-34), the LV end systolic volume index is 219 ml/m2 (normal range 25+/-9), the LVESV is 399 ml (normal range 47+/-19), the LV mass index is elevated at 121 g/m2 (normal range 85+/-15), and the LV mass is 220 g (normal range 164+/-36). There is global hypokinesis with regional variation; notably the inferior wall is thinned and akinetic. There is no apical thrombus noted. There is late gadolinium enhancement which is predominately transmural, suggestive of previous myocardial infarction, which involves the extent of the inferior and inferolateral walls, suggesting non-viability. There is additionally an atypical pattern (mid-wall stripe) of late gadolinium enhancement involving the basal to septum. This pattern is not consistent with prior myocardial infarction and suggests the presence of a concomitant non-ischemic/ dilated cardiomyopathy. The remainder of the myocardium (left anterior descending) is free of late gadolinium enhancement and likely to be viable. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 27%, the RV end diastolic volume index is 102 ml/m2 (normal range 82+/-16), the RVEDV is 186 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 136 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve is bicuspid with fusion of the left and right coronary cusps. There is at least moderate aortic regurgitation, which appears eccentric. The regurgitant fraction is 35%.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 normal brachiocephalic branching pattern. The aortic root is mildly dilated The sinus of valsalva is dilated (44x43mm). The ascending aorta measures 37x37mm, and the proximal transverse arch measures 29mm. There is no evidence of coarctation or aortic dissection.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (34mm at the level of the ascending aorta).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. The left ventricle is severely dilated with severely reduced systolic function (EF 14%). 2. There is a transmural myocardial infarction in the usual territory of the left circumflex or a large right coronary artery. This territory is not viable. The LAD territory is free of myocardial infarction and is likely to be viable. 3. There is additionally evidence of myocardial fibrosis involving the mid-wall of the basal to mid septum which is not due to a myocardial infarction and suggests that there is also a concomitant non-ischemic cardiomyopathy present.4. Normal size RV with severely reduced function (RVEF 27%). 5. Bicuspid aortic valve with at least moderate aortic regurgitation. 6. Mildly dilated aortic root without evidence of thoracic aortic dissection or coarctation.7. Biatrial dilatation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.