60 year old male with diabetes, hypertension, hyperlipidemia, peripheral arterial disease who presented with myocardial infarction. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 74 ml/m2 (normal range: 74+/-15), the LVEDV is 136 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 62 ml (normal range 47+/-19), the LV mass index is 46 g/m2 (normal range 85+/-15), and the LV mass is 84 g (normal range 164+/-36). There are regional wall motion abnormalities. In the inferior wall there is dyskinesis at the base and mid ventricle with small pseudoaneurysm formation. This area appears black on LGE sequences which is consistent with significant microvascular obstruction. The basal to mid inferoseptum and inferolateral walls are akinetic. There is transmural late gadolinium enhancement in the basal to mid inferior and inferolateral walls. The basal to mid inferior, inferoseptum and inferolateral walls are not likely to be viable. There is a small patch of late gadolinium enhancement in the mid anteroseptum which is not transmural. The anterior, anteroseptum, lateral and apical walls are all viable. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 138 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 71 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 no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.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 a small pericardial effusion.Extracardiac FindingsThere is a small pleural effusion on the left. 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. The left ventricle is normal in size with low normal systolic function (LVEF 54%). 2. There are regional wall motion abnormalities in the basal to mid inferoseptum, inferior and inferolateral walls. There is a small pseudoaneurysm in the mid inferior wall corresponding to an area of microvascular obstruction due to myocardial infarction. There is transmural late gadolinium enhancement in the basal to mid inferior and inferolateral walls. These areas are not likely to be viable. 3. There is a small patch of late gadolinium enhancement in the mid anteroseptum which is not transmural. The anterior, anteroseptum, lateral and apical walls are all viable. 4. The right ventricle is normal in size with low normal systolic function (RVEF 48%)5. Small pericardial effusion6. Small left sided pleural effusionI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.