66 year old man with prior myocardial infarction now presenting with atypical chest pain and is referred to evaluate for ischemia and viability.MEDICATIONS: ASA, atorvastatin, lisinopril, and metoprolol First Pass PerfusionDuring hyperemia, there were perfusion abnormalities involving the basal anterior, anterolateral, inferolateral, inferior, and inferoseptal walls and the mid inferior wall. All of the perfusion defects except the basal anterior wall are a result of the below described myocardial infarctions. Viability/ Myocardial ScarThe are transmural myocardial infarctions involving the basal anterolateral, inferolateral, inferior, and inferoseptal walls; the mid inferior and inferolateral walls, and the apical inferior wall. These segments are unlikely to be viable. The remainder of the myocardium is free of myocardial infarction and likely to be viable.Left VentricleThe left ventricle is normal in size with mildly reduced overall systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 172 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 90 ml (normal range 47+/-19), the LV mass index is 52 g/m2, and the LV mass is 98 g. There is severe hypokinesis of the basal to mid anterolateral, inferolateral, and inferior walls.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 112 ml/m2 (normal range 82+/-16), the RVEDV is 212 ml (normal range 142+/-31), the RV end systolic volume index is 53 ml/m2 (normal range 31+/-9), and the RVESV is 100 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 mild 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 extensive transmural myocardial infarction involving much of the RCA and LCx territory which is unlikely to be viable. 2. There is a small amount of ischemia involving the basal anterior wall. There is no associated myocardial scar in this segment and it is likely to be viable. The remainder of the above described perfusion defects are secondary to transmural scar in territories that are not viable.3. Normal LV size with mildly reduced systolic function (LVEF 48%). There is severe akinesis of the basal to mid inferior, inferolateral, and anterolateral walls.4. Normal RV size and systolic function (RVEF 53%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.