40 year old woman with history of spontaneous LAD dissection s/p PCI, LV dysfunction referred for interval imaging to evaluate ejection fraction and scar burden. Left VentricleThe left ventricle is moderate-severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 110 ml/m2 (normal range: 65+/-11), the LVEDV is 175 ml (normal range 109+/-23), the LV end systolic volume index is 60 ml/m2 (normal range 18+/-5), the LVESV is 96 ml (normal range 31+/-10), the LV mass index is 30 g/m2 (normal range 67+/-11), and the LV mass is 46 g (normal range 114+/-24). There is akinesis of the basal and apical anterior wall, and dyskinesis in the mid segment, with associated thinning. There is hypokinesis of the mid and apical septum. There is transmural late gadolinium enhancement in the entirety of the anterior wall, and mid to apical septum, which suggests previous myocardial infarction with minimal viability.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is mildly enlarged.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 79 ml/m2 (normal range 69+/-14), the RVEDV is 126 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 57 ml (normal range 35+/-13). 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 normal brachiocephalic branching pattern. The aortic root is normal in size. The thoracic aorta and proximal brachiocephalic vessels do not have evidence of aneurysm or dissection. The abdominal and infrarenal aorta do not have evidence of aneurysm or dissection. 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 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. Moderately to severely enlarged left ventricle with mildly reduced systolic function (LVEF 45%). While the ejection fraction is unchanged, the left ventricular volumes are larger than on the previous study from 12/3/2014. 2. There is akinesis of the basal and apical anterior wall, and dyskinesis in the mid segment, with associated thinning. There is hypokinesis of the mid and apical septum. There is transmural late gadolinium enhancement in the entirety of the anterior wall, and mid anteroseptum. This appears similar to the previous study. 3. Normal size right ventricle with normal systolic function (EF 54%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.