60 year old with history of hypertension, coronary artery disease s/p CABG, aortic pseudoaneurysm s/p repair. MEDICATIONS: coumadin, lisinopril, furosemide, atorvastatin, and metoprolol First Pass PerfusionDuring hyperemia, there are perfusion abnormalities in the basal and mid anterior, anteroseptum, inferoseptal, and inferior walls; and in the apical inferior wall. Viability/ Myocardial ScarThere is a transmural (>50%) late gadolinium enhancement noted involving much of the inferior wall in a pattern consistent with prior myocardial infarction. This area of infarction is unlikely to be viable, however remaining myocardium is viable. Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. There is left ventricular hypertrophy that is asymmetric (ventricular septum 14 mm, posterior wall 11mm) The overall LV ejection fraction is 46%, the LV end diastolic volume index is 121 ml/m2 (normal range: 74+/-15), the LVEDV is 256 ml (normal range 142+/-34), the LV end systolic volume index is 66 ml/m2 (normal range 25+/-9), the LVESV is 139 ml (normal range 47+/-19), the LV mass index is 89 g/m2, and the LV mass is 189 g. There is severe hypokinesis of the mid-basal inferior and inferoseptal walls. The remaining wall motion appears normal. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 41%, the RV end diastolic volume index is 88 ml/m2 (normal range 82+/-16), the RVEDV is 187 ml (normal range 142+/-31), the RV end systolic volume index is 53 ml/m2 (normal range 31+/-9), and the RVESV is 111 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is at least moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and 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.AortaThe aortic root is normal in size. Beyond the sinus of Valsalva the ascending aorta is poorly seen due to artifact. Pulmonary VeinsThe right sided pulmonary veins drain normally into the left atrium. The left upper pulmonary vein drains normally into the left atrium and the left inferior pulmonary vein is not clearly seen due to artifact. Pulmonary ArteryThe pulmonary artery and its proximal branches are obscured by artifact. Venous AnatomyThe SVC and IVC drain normally into the right atrium. The IVC appears to be enlarged. PericardiumThere is no obvious pericardial disease. The previously noted abscess is no longer present.Extracardiac FindingsThere appears to be mesenteric fat extending into the superior portion of the mediastinum through a ventral diaphragmatic hernia. There are sternal wires present. There is metallic artifact in the ascending aorta obscuring the PA and the entire ascending aorta consistent with patient's dissection repair with multiple occluder devices. 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 are 2 ischemic territories. The perfusion defect in the right coronary artery territory is secondary to an inferior wall transmural myocardial infarction and the territory is not likely to be viable. The 2nd defect involves much of the LAD territory and is likely to be viable. 2. Moderately dilated LV with mildly reduced systolic function (LVEF 46%) with severe hypokinesis of the basal to mid inferior and inferoseptal walls.3. Normal RV size with mildly reduced systolic function (RVEF 41%).4. At least moderate aortic insufficiency. 5. See extra-cardiac findings.When compared to the prior study from 7/20/2010, the pericardial abscess is no longer present.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.