61 year old with history of cardiac arrest presenting for evaluation prior to ICD implantation. Left VentricleThe left ventricle is mildly enlarged with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 97 ml/m2 (normal range: 65+/-11), the LVEDV is 207 ml (normal range 109+/-23), the LV end systolic volume index is 44 ml/m2 (normal range 18+/-5), the LVESV is 94 ml (normal range 31+/-10), the LV mass index is 54 g/m2 (normal range 67+/-11), and the LV mass is 114 g (normal range 114+/-24). There is a regional wall motion abnormality in the basal inferior-inferolateral wall, further, there is a moderate-size area of transmural late gadolinium enhancement in the same area suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is additionally evidence of increased T2-signal in the basal inferolateral wall, seen on the SSFP images. These findings are most consistent with recent myocardial infarction in the territory of a obtuse marginal artery or posterolateral artery. There is mild left ventricular hypertrophy. Left AtriumThe left atrium is mildly enlarged.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 84 ml/m2 (normal range 69+/-14), the RVEDV is 178 ml (normal range 110+/-24), the RV end systolic volume index is 46 ml/m2 (normal range 22+/-8), and the RVESV is 97 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly enlarged. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The descending thoracic aorta is mildly dilated (36mm); there is additionally evidence of a small penetrating aortic ulcer in the mid-portion of the descending thoracic 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 drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsThyroid enlargement is noted. There are trivial bilateral pleural effusions. 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. Left ventricle is mildly enlarged with low normal systolic function (LVEF 54%). There is a regional wall motion abnormality in the basal inferior-inferolateral wall, with an area of moderate-sized area of transmural LGE in a pattern most consistent with a recent myocardial infarction. 2. Right ventricle is normal in size with mildly reduced systolic function (RVEF 46%). 3. The descending thoracic aorta is mildly dilated (36mm) and has a small penetrating aortic ulcer in the mid-portion.4. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.