85 year-old female with history of myocardial infarction and subsequent cath showing significant coronary disease. MRI to assess for viability. Of note, due to limited ability to follow breath holding instructions, this study quality is sub-optimal limiting quantification of ventricular volumes, ejection fraction and valvulopathy.Left VentricleThe left ventricle is mild to moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 97 ml/m2 (normal range: 65+/-11), the LVEDV is 174 ml (normal range 109+/-23), the LV end systolic volume index is 71 ml/m2 (normal range 18+/-5), the LVESV is 128 ml (normal range 31+/-10). There is akinesis of the inferoseptal and antero septal walls from base to apex. There is apical dyskinesis. There is hypokinesis of the anterior wall. The inferior and inferolateral walls are the only segments that have close to normal wall motion. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The entire 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 33%, the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVEDV is 148 ml (normal range 110+/-24), the RV end systolic volume index is 55 ml/m2 (normal range 22+/-8), and the RVESV is 99 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 quality of the study limits assessment of mitral regurgitation. Suggest alternative imaging to quantify 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.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 no obvious pericardial disease.Extracardiac FindingsThere are bilateral pleural effusions. 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 mild to moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 27%2. There is akinesis of the inferoseptal and antero septal walls from base to apex. There is apical dyskinesis. There is hypokinesis of the anterior wall. The inferior and inferolateral walls are the only segments that have close to normal wall motion. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The entire myocardium is viable.3. The right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 33%4. Severely dilated left atrium. Mildly dilated right atrium.5. This was a technically challenging study due to limited patient cooperation with breath-holds. 6. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.