62 year old man with coronary artery disease s/p CABG in 1998 with known occluded SVG to RCA and OM. He is referred to assess for ischemia and viability.MEDICATIONS: aspirin, clopidogrel, lisinopril, metoprolol First Pass PerfusionDuring hyperemia, there was a perfusion defect involving the basal inferior, inferolateral, and anterolateral wall.Viability/ Myocardial ScarThere are 2 large myocardial infarctions (i.e. late gadolinium enhancement). The first is transmural and involves the basal to mid inferior walls (RCA territory). These segments are very unlikely to be viable. The second is non-transmural and involves the basal to mid inferolateral and anterolateral walls (LCx territory) and has an intermediate probability of viability. The remainder of the myocardium (LAD territory) is free of myocardial infarction and is viable.Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. There is akinesis of the basal to mid inferior, inferolateral, and anterolateral walls. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 142 ml/m2 (normal range: 74+/-15), the LVEDV is 289 ml (normal range 142+/-34), the LV end systolic volume index is 94 ml/m2 (normal range 25+/-9), the LVESV is 191 ml (normal range 47+/-19), the LV mass index is 62 g/m2, and the LV mass is 126 g. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 165 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 78 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 no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant 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 FindingsThere are numerous masses in the liver, consistent with the patient's diagnosis of metastatic renal cell cancer. 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. There is a large severe perfusion defect involving the basal inferior, inferolateral and anterolateral walls during hyperemia.2. There are 2 large myocardial infarctions (i.e. late gadolinium enhancement). The first is transmural and involves the basal to mid inferior walls (RCA territory). These segments are very unlikely to be viable. The second is non-transmural and involves the basal to mid inferolateral and anterolateral walls (LCx territory) and has an intermediate probability of viability. The remainder of the myocardium (LAD territory) is free of myocardial infarction and is viable.3. Severe LV dilation with moderately reduced systolic function (LVEF 34%) with akinesis of the basal to mid inferior, inferolateral, and anterolateral walls. 4. Normal RV size and systolic function (RVEF 52%).5. See extra-cardiac findings.