75 year old man with CABG x2, multiple PCI, ascending aortic repair and chronic type B dissection, referred for evaluation of viability. Left VentricleThe left ventricle is mildly dilated with moderate to severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 115 ml/m2 (normal range: 74+/-15), the LVEDV is 230 ml (normal range 142+/-34), the LV end systolic volume index is 82 ml/m2 (normal range 25+/-9), the LVESV is 163 ml (normal range 47+/-19). There is apical akinesis with associated thinning. There is hypokinesis of the mid to apical anteroseptal and septal walls. There is akinesis of the mid to apical inferior wall. There is late gadolinium enhancement in the distal to apical septum and anteroseptum that appears transmural and consistent with prior infarct. This area is not likely to be viable. There is subendocardial LGE in the mid anteroseptum / septum that occupies about 50% of the myocardium and is consistent with prior infarct. This area has intermediate probability of viability. The remaining myocardium is viable.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 106 ml/m2 (normal range 82+/-16), the RVEDV is 212 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 149 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThere is systolic turbulence across the AV. The number of leaflets cannot be determined on this study. There is mild to moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation. There is mild to moderate annular calcification. There is thickening of the anterior valve leaflet.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. There is evidence of aortic root/ascending aorta graft repair. The aortic root in normal in size. Distal to the repair anastomosis begins a type B thoracic aortic dissection. This appears similar to outside CT report description. The true lumen in the descending thoracic aorta is narrowed.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are moderate bilateral pleural effusions with atelectasis. 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.
The left ventricle is mildly dilated with moderate to severely reduced systolic function. The overall LV ejection fraction is 29%.There is apical akinesis with associated thinning. There is hypokinesis of the mid to apical anteroseptal and septal walls. There is akinesis of the mid to apical inferior wall. There is late gadolinium enhancement in the distal to apical septum and anteroseptum that appears transmural and consistent with prior infarct. This area is not likely to be viable. There is subendocardial LGE in the mid anteroseptum / septum that occupies about 50% of the myocardium and is consistent with prior infarct. This area has intermediate probability of viability. The remaining myocardium is viable.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.