74 year old woman with complex CAD, referred for evaluation of viability. Left VentricleThe left ventricle is severely dilated with mild to moderately reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 139 ml/m2 (normal range: 65+/-11), the LVEDV is 230 ml (normal range 109+/-23), the LV end systolic volume index is 83 ml/m2 (normal range 18+/-5), the LVESV is 137 ml (normal range 31+/-10), the LV mass index is 87 g/m2 (normal range 67+/-11), and the LV mass is 145 g (normal range 114+/-24). There is hypokinesis of the basal to mid inferior and inferolateral walls, as well as the mid to distal lateral wall. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The entire myocardium is viable.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVEDV is 133 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 55 ml (normal range 35+/-13). 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 leaflets are thickened. There is posterior tethering and malcoaptation of the leaflets. There is moderate to severe mitral regurgitation (ischemic etiology).Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. There is mild atherosclerosis of the descending aorta.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 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. The left ventricle is severely dilated with mild to moderately reduced systolic function. The overall LV ejection fraction is 40%.2. There is a large territory of hypokinesis involving basal to mid inferior and inferolateral walls, as well as the mid to distal lateral wall. There is no late gadolinium enhancement to suggesting this entire territory is very likely viable. There is also no evidence of myocardial infarction in the remainder of the ventricle which is also viable. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%.4. Moderate to severe ischemic mitral regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.