69 yo man with hx of recent TECAB (LIMA to LAD/D1 and RIMA to OM1) who has a CTO of distal RCA that was previously patent. MRI to assess for ischemia in RCA territory to help decide on whether CTO PCI is warranted. First Pass PerfusionDuring hyperemia, there is presence of perfusion defect in the mid and basal inferior and inferolateral walls. The overall ischemia score is 3 out of a possible 32. Approximately 9% of the myocardium is ischemic. Viability/ Myocardial ScarThere is no evidence of myocardial infarction. The entire myocardium is likely to be viable. Left VentricleThe left ventricle is normal in size with mild to moderately decreased systolic function. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 150 ml/m2 (normal range: 74+/-15), the LVEDV is 306 ml (normal range 142+/-34), the LV end systolic volume index is 62 ml/m2 (normal range 25+/-9), the LVESV is 126 ml (normal range 47+/-19). There is hypokinesis of the basal to mid inferior and inferolateral walls. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 104 ml/m2 (normal range 82+/-16), the RVEDV is 211 ml (normal range 142+/-31), the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9), and the RVESV is 95 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 moderate 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall 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 basal to mid inferior and inferolateral walls are hibernating, ischemic, and viable. 2. There is no evidence of myocardial infarction. The entire left ventricle is viable. 3. Normal LV size with mild to moderately decreased systolic function. (LVEF 41%).4. Normal RV size and systolic function (RVEF 55%).5. Moderate mitral regurgitation. 