64 year old man with history of ischemic cardiomyopathy s/p CABG, referred for viability assessment. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 217 ml/m2 (normal range: 74+/-15), the LVEDV is 410 ml (normal range 142+/-34), the LV end systolic volume index is 188 ml/m2 (normal range 25+/-9), the LVESV is 355 ml (normal range 47+/-19). There is apical dyskinesis. There is akinesis of the mid-distal lateral wall, mid to apical anterior/anteroseptal walls, mid to apical septum and inferoseptum with associated thinning of the myocardium. There is late gadolinium enhancement in a transmural pattern, suggesting non-viability in nearly all of the hypokinetic segments described, other than a very small basal segment of the lateral wall and mid septum.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 80 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 85 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet and opens widely. There is mild aortic regurgitation.Mitral ValveThe mitral valve is apically displaced due to bileaflet tethering. There is 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 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 dilated.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThere are moderate 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 severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%.2. There is an extensive wall motion abnormality with predominately no viability on LGE imaging.3. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 44%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.