A 77 year old male with past history of ischemic heart disease (s/p CABG , s/p PCI), congestive heart failure, diabetes mellitus, hypertension, atrial fibrillation, peripheral artery disease, prostate cancer. The patient is now hospitalized due to heart failure exacerbation and cerebral circulation insufficiency while the echocardiography showed worsening of the left and right ventricular function. Left VentricleThe left ventricle is mildly dilated with severely decreased systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 115 ml/m2 (normal range: 74+/-15), the LVEDV is 206 ml (normal range 142+/-34), the LV end systolic volume index is 99 ml/m2 (normal range 25+/-9), the LVESV is 178 ml (normal range 47+/-19), the LV mass index is 83 g/m2 (normal range 85+/-15), and the LV mass is 149 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is transmural late gadolinium enhancement in the distal anterior-septum and non-transmural in the distal inferior-septum. This finding suggest fibrosis compatible with previous myocardial infarction in the distal LAD territory and is probably not viable. There is a second pattern of mid-wall late gadolinium enhancement involving the basal anteroseptum. This pattern is most likely consistent with fibrosis due to a concomitant non-ischemic type of cardiomyopathy, this territory has indeterminate viability. The remainder of the myocardium is free of late gadolinium enhancement and is potentially viable. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is in the upper normal range with severely reduced systolic function. The overall RV ejection fraction is 17%, the RV end diastolic volume index is 113 ml/m2 (normal range 82+/-16), the RVEDV is 203 ml (normal range 142+/-31), the RV end systolic volume index is 94 ml/m2 (normal range 31+/-9), and the RVESV is 169 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.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 mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC is mildly dilated and the IVC is dilated. The coronary sinus is dilated.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires were noted. Mild bilateral pleural effusion was noted. 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 mildly dilated with severely decreased systolic function, the LVEF is 14%. 2. There is transmural late gadolinium enhancement in the distal anterior-septum and non-transmural in the distal inferior-septum. This finding is compatible with previous myocardial infarction in the distal LAD territory and is probably not viable. There is a second pattern of mid-wall late gadolinium enhancement involving the basal anteroseptum. This pattern is most likely consistent with fibrosis due to a concomitant non-ischemic type of cardiomyopathy, this territory has indeterminate viability. The remainder of the myocardium is free of late gadolinium enhancement and is potentially viable. 3. The right ventricle is in the upper normal range with severely reduced systolic function, the RVEF is 17%. 4. The left atrium is moderately dilated. 5. The right atrium is mildly dilated.6. There is moderate mitral regurgitation.7. There is mild to moderate tricuspid regurgitation.8. The aortic root is mildly dilated.9. The main pulmonary artery is mildly dilated.10. The SVC is mildly dilated and the IVC is dilated.11. There is mild bilateral pleural effusion (R>L).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.