A 74 year old female with personal history of coronary artery disease (VF arrest in 1998 with PCI to prox LAD), left ventricular systolic dysfunction (LVEF 43% by last echo from 2013), mild mitral regurgitation and indolent multiple myeloma. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 86 ml/m2 (normal range: 65+/-11), the LVEDV is 147 ml (normal range 109+/-23), the LV end systolic volume index is 46 ml/m2 (normal range 18+/-5), the LVESV is 79 ml (normal range 31+/-10). There is an extensive apical aneurysm with a thin myocardium. There is late gadolinium enhancement in all the segments of the apex affecting the entire wall (transmural). This finding represents fibrosis and has a pattern of old myocardial infarction and non-viability. There is a mural thrombus in the apex with a maximal thickness of 4.5mm.No myocardial iron overload was noted.Left AtriumThe left atrium is normal in size. The LA volume is 86 ml.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 111 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 46 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a "pseudo bovine" pattern (normal variant). 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 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. The left ventricle is normal in size with mildly reduced systolic function, the LVEF is 46%. There is an extensive apical aneurysm with a thin myocardium. 2. There is late gadolinium enhancement in all the segments of the apex affecting the entire wall (transmural). This finding represents fibrosis and has a pattern of old myocardial infarction and non-viability. 3. There is a mural thrombus in the apex with a maximal thickness of 4.5mm.4. The right ventricle is normal in size and systolic function, the RVEF is 58%. 5. There is at least mild mitral regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.