58 year old male with hx of multivessel CAD, s/p multiple PCI, s/p CABG 2/2016 (Lima to LAD, SVG to DG and SVG to OM), PVC ablation. Now with fatigue and angina x 2-3 weeks. MEDICATIONS: amlodipine, aspirin, rosuvastatin, lisinopril, prasugrel, lorazepam. First Pass PerfusionDuring hyperemia, there was an area of hypoperfusion in the basal inferior and inferoseptal wall, which corresponds to the below described myocardial infarction. Viability/ Myocardial ScarThere is late gadolinium enhancement in more than 50% of the thickness of the wall at the basal inferior wall compatible with an old transmural myocardial infarction. This segment is not likely to be viable. The remainder of the left ventricle is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 77 ml/m2 (normal range: 74+/-15), the LVEDV is 194 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 60 g/m2, and the LV mass is 151 g. There is an area of thinning and hypokinesis of the basal to mid inferior wall . The native T1 myocardial relaxation time in this area was also elevated at 1166 ms suggestive of diffuse fibrosis or inflammation. The native T1 myocardial relaxation times in the septum and ventricular lateral wall were normal <1030 ms.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 88 ml/m2 (normal range 82+/-16), the RVEDV is 223 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 93 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 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.There is a transmural myocardial infarction involving the basal inferior wall similar to previous MRI 6/2016. Most of the infarcted segment is not likely to be viable. The remainder of the myocardium is free of myocardial infarction or ischemia and is viable.2.The left ventricle is normal in size with normal systolic function. LVEF 63%3.The right ventricle is mildly dilated with normal systolic function. RVEF 58%I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.