70 year old man with history of hypertension, diabetes, hyperlipidemia and recent CABG (RIMA to LAD, LIMA to obtuse marginal) with known occlusion of the RCA, referred for assessment of ischemic burden and viability in the RCA territory.MEDICATIONS: aspirin, atorvastatin, metoprolol, losartan, metformin, glimepiride First Pass PerfusionDuring hyperemia, there is a severe perfusion defect involving the basal inferoseptal, inferior, and inferolateral walls and the mid inferolateral walls, which extends slightly beyond the below described myocardial infarction. There is also a mild perfusion defect involving the basal anteroseptum, anterior, and anterolateral walls. Viability/ Myocardial ScarThere is a predominantly non-transmural myocardial infarction (i.e. <50% of wall thickness) involving the basal to anterolateral, inferolateral, and inferior walls. These territories have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 150 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 61 g/m2, and the LV mass is 130 g. There is thinning and associated akinesis of the basal to mid inferior and inferolateral walls.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 69%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 138 ml (normal range 142+/-31), the RV end systolic volume index is 20 ml/m2 (normal range 31+/-9), and the RVESV is 43 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 . 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is mild atherosclerosis of the descending aorta.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 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 large myocardial infarction involving the basal to mid inferior and inferolateral wall. The territory has an intermediate probability of viability and a small amount of peri-infarct ischemia which extends into the basal inferoseptum.2. There is mild ischemia involving the basal anteroseptum, anterior, and anterolateral walls. Most of this territory is free of myocardial infarction and is predominantly viable. 3. Normal LV size with low normal systolic function (LVEF 51%) with akinesis of the basal to mid inferior and inferolateral walls.4. Normal RV size and systolic function (RVEF 69%).5. Mild to moderate mitral regurgitation.6. Mild atherosclerosis of the descending aorta.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.