a 53 years old female with history of coronary artery disease with a CABG in 2006 (LIMA to CX, RIMA to LAD) and 2008 (SVG to DG, RI and OM1) + PCI to LAD prox+mid and LM into CX. Now presenting with increasing angina, referred to cardiac MR for evaluation of ischemia. MEDICATIONS: Aspirin, Clopidogrel, Atorvastatin, Metoprolol, Amlodipine, Nitroglicerin First Pass PerfusionDuring hyperemia, there is a severe and extensive perfusion defect which involves the entire ventricle except the basal infero-septum and apical lateral wall. Viability/ Myocardial ScarThere was a small amount of non-transmural late gadolinium enhancement noted in the basal inferolateral segment suggesting that there is prior myocardial infarction. This segment has an intermediate probability of viabiltiy. The remainder of the myocardium is free of myocardial infarction and is viable. Left VentricleThe left ventricle is normal in size with low normal systolic function. There is akinesis of the inferolateral wall. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 165 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 82 ml (normal range 31+/-10), the LV mass index is 49 g/m2, and the LV mass is 101 g. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 69 ml/m2 (normal range 69+/-14), the RVEDV is 140 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. 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 no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.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. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are noted. Axillary lymphadenopathy is 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. Extensive myocardial ischemia as described above.2. A small, non-transmural myocardial infarction is noted in the basal inferolateral wall. This segment has an intermediate probabilty of viability. The remainder of the myocardium is free of myocardial infarction and is highly likely to be viable.3. Normal LV size and systolic function (LVEF 50%) with akinesis of most of the inferolateral wall.4. Normal RV size and systolic function (RVEF 57%).5. Mild biatrial dilation.6. Mild mitral and tricuspid regurgitation.7. Extra-cardiac findings as above. Findings conveyed to Dr. Nathan. 