76 year old male with dyspnea on exertion as anginal equivalent, found to have CTO on recent angiogram. Assess for viability.MEDICATIONS: aspirin, atorvastatin, chlorthalidone Viability/ Myocardial ScarThere was a nontransmural myocardial infarction (<50% wall thickness) involving the basal inferolateral wall. Based on late gadolinium enhancement imaging, this segment has an intermediate probability of viability; however, this segment has improved contractility which would suggest that the segment is in fact likely to be viable. The remainder of the ventricle is free of myocardial infarction and improves following dobutamine infusion which suggests that it is viable. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 47%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 120 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 64 ml (normal range 47+/-19), the LV mass index is 51 g/m2, and the LV mass is 96 g. During resting conditions, there is mild global hypokinesis; however, following the administration of dobutamine, the systolic function normalizes. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 149 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 83 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 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 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 non-transmural myocardial infarction in the basal inferolateral wall; however, this segment has improved contractility following the administration of dobutamine suggesting that it is likely to be viable. The remainder of the myocardium is free of myocardial infarction and also viable. 2. Normal LV size with mildly reduced systolic function (LVEF 47%).3. Normal RV size with mildly reduced systolic function (RVEF 44%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.