History of multiple prior myocardial infarctions. Additional history of polysubstance abuse. Evaluate for viability. Left VentricleThe left ventricle is non dilated. The lateral wall and inferior wall are thinned with compensatory hypertrophy of the anterior septum. The apex is also markedly thinned and aneurysmal. The inferior and lateral wall are akinetic and the apex is dyskinetic. Within the apical aneurysm there is an approximately 2 cm thrombus. The overall LV ejection fraction is 37% Transmural delayed gadolinium enhancement is present in the inferior wall, lateral wall, and apex compatible with prior infarcts of the RCA, circumflex, and distal LAD. There is an additional small patchy subendocardial focus in the mid septum also compatible with ischemia (series 2001 image 1).Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 56%. Right AtriumThe right atrium is unremarkable. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study. The valve leaflets appear mildly thickened.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study. The valve leaflets appear mildly thickened.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 are normal in size and drain normally into the right atrium. PericardiumSmall pericardial effusion.Extracardiac FindingsIncompletely evaluated cystic focus in the superior pole of the left kidney.
1. Findings of prior left circumflex, RCA, and distal LAD infarcts with transmural delayed gadolinium enhancement as described. Additional focus of subendocardial enhancement in the mid septum compatible with ischemia. The infarcted territories demonstrate marked wall thinning and there is associated compensatory hypertrophy of the anterior septum.2. Left ventricular apical aneurysm containing a 2 cm thrombus.3. Left ventricular wall motion abnormalities as described with an ejection fraction of 37%. Cardiac parameters will be listed as an addendum when they become available.