61 year old with history of ischemic cardiomyopathy admitted with worsening heart failure being worked up for advanced options. Left VentricleThe left ventricle is massively dilated with severely reduced systolic function. The overall LV ejection fraction is 10%, the LV end diastolic volume index is 403 ml/m2 (normal range: 74+/-15), the LVEDV is 678 ml (normal range 142+/-34), the LV end systolic volume index is 363 ml/m2 (normal range 25+/-9), the LVESV is 611 ml (normal range 47+/-19), the LV mass index is 163 g/m2 (normal range 85+/-15), and the LV mass is 275 g (normal range 164+/-36). The left ventricular dysfunction is global with regional variation. There is thinning with dyskinesis of the mid to apical inferior wall and severe hypokinesis of the basal to mid anterior, anteroseptal, and inferoseptal walls. There are two distinct late gadolinium enhancement patterns. The first is transmural late gadolinium enhancement in the mid to apical inferior walls. This finding is most likely due to myocardial infarction and suggests that these segments are not viable. The second is a mid-wall stripe pattern in the interventricular septum. This finding is a non-infarction pattern and suggests a second non-ischemic etiology of the LV dysfunction, in addition to the ischemic etiology. Given the fact that there is also a significant non-ischemic component to the LV dysfunction, it is difficult to predict whether the other myocardial segments are viable. Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is moderately dilated with mild-moderately reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 143 ml/m2 (normal range 82+/-16), the RVEDV is 241 ml (normal range 142+/-31), the RV end systolic volume index is 86 ml/m2 (normal range 31+/-9), and the RVESV is 145 ml (normal range 54+/-17).Right AtriumThe right atrium is mild-moderately dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate-severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate to severe tricuspid regurgitation.AortaThere is a left sided aortic arch with a "pseudo-bovine" brachiocephalic branching pattern with common origin of right innominate and left common carotid (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 mildly dilated. Venous AnatomyThe SVC is normal in size and drains normally into the right atrium. The IVC is dilated. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsRenal cyst 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. Severe LV dilation with severely reduced systolic function (LVEF 10%) with both ischemic and non-ischemic etiologies.2. There is a transmural myocardial infarction involving the mid to apical inferior wall. These segments are not viable.3. There is mid-wall fibrosis involving much of the basal to mid anterior wall and septum. It is unclear whether these segments are viable given the fibrosis is non-ischemic in etiology.4. Moderate RV dilation with mild to moderate RV systolic dysfunction (RVEF 40%.5. Severe left atrial dilation.6. Moderate to severe mitral and tricuspid valve regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.