A 63 year old male with a recent (11/1/2015) ST elevation myocardial infarction, the left cardiac cath showed Left Anterior Descendent artery with a 100% thrombotic occlusion on the proximal portion and a 100% occlusion of the Right coronary artery. The LAD was opened with PCI and stent. The echocardiography showed severely decreased left ventricular function. A non-sustained ventricular tachycardiac was noted on the monitor. Referred to cardiac MRI for further investigation. Left VentricleThe left ventricle is moderately dilated with severely decreased systolic function. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 131 ml/m2 (normal range: 74+/-15), the LVEDV is 291 ml (normal range 142+/-34), the LV end systolic volume index is 96 ml/m2 (normal range 25+/-9), the LVESV is 213 ml (normal range 47+/-19), the LV mass index is 77 g/m2 (normal range 85+/-15), and the LV mass is 171 g (normal range 164+/-36). There are two large myocardial infarctions. The first involves the LAD territory (basal antero-septum and inferoseptum; mid anterolateral, anterior, anteroseptal, and inferoseptal walls; apical lateral, anterior, and septal walls; and the apical cap). This is the acute infarction and is transmural with extensive amounts of associated microvascular obstruction and a severe wall motion abnormality. These territories are not viable. The second myocardial infarction is chronic and involves the entire inferior wall. This infarction is nearly transmural and is also not likely to be viable. This territory is all associated with hypokinesis. No left ventricular thrombus was seen.No myocardial iron overload was noted.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 194 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 95 ml (normal range 54+/-17).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 mild to moderate 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.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 mild pericardial effusion.Extracardiac FindingsPulmonary congestion was noted. 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. The left ventricle is moderately dilated with severely decreased systolic function (LVEF 27%) without evidence of an LV thrombus. 2. There are two large myocardial infarctions. The first involves a very large portion of the LAD territory . It is the acute infarction and is transmural with extensive amounts of associated microvascular obstruction. The second myocardial infarction is chronic and involves the entire inferior wall. This infarction is nearly transmural. Neither territory is likely to be viable. 3. No left ventricular thrombus was seen.4. The left atrium is mildly dilated. 5. The right ventricle is normal in size and systolic function, the RVEF is 51%. 6. There is mild to moderate mitral regurgitation.7. There is mild pericardial effusion.8. Pulmonary congestion was notedI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.