Echo cases | Bssp

Should that territory be revascularized??

•Likelihood of viability decreased progressively as the transmural extent of DE increased (P<0.001).

•Of all dysfunctional segments there is 71% chance of improvement in segments <=25% transmural extent of hyperenhancement and 7.7% improvement in those segments with >50%. Kim. NEJM 2000;343:1445-53

Reavscularization of the LAD?

Short Axis - Free breathing

Gated FIESTA and MDE (Myocardial delayed enhancement). The patient was unable to cooperate with breath-holding. LVEF calculated to be 25%.

Apical 2-chamber

Gated FIESTA and MDE. MDE's were repositioned to be on the same orientation of gated-FIESTA.

4-Chamber

Long TI for clot. Not clot clearly seen but microvascular obstruction suggestive of no-reflow. Imaged at 270 ms TI 19 min latter the decreased perfusion area is mostly filled by Gd and confirming no reflow.

Short Axis - Free breathing

Gated FIESTA and MDE (Myocardial delayed enhancement). The patient was unable to cooperate with breath-holding. LVEF calculated to be 25%.

1/4

S/p extensive anteroapical MI with late presentation. TO pLAD, 70% mRCA. Complicated by acute left middle cerebral artery infarct s/p intra-arterial tPA. CMR done to determine if revascularization of LAD was needed.

" The MRI result was reviewed with Dr. Pessanha. She mostly has extensive scar in the LAD distribution. No areas of liability are suggested. The official report by the radiologist uses the term "ischemia," which is not appropriate in this setting and the term "scar" should be replacing this term. I did not get a chance to clarify this with him as he is no longer available; we will discuss it tomorrow."

Non-viable vs. Ischemic viable myocardium

IMPRESSION: Extensive transmural ischemia or fibrosis throughout all apical segments.Additional transmural ischemia is seen throughout the mid ventricle and at the base of the left ventricle as detailed above. Findings include evidence of acute ischemia involving the anterior and anteroseptal walls. Severely decreased ejection fraction at 25%. Moderate-sized bilateral pleural effusions.Findings discussed with Dr. Pessanha at 2pmREPORT READ BY:STEVEN GERSTLER, M.D.REPORT ELECTRONICALLY SIGNED BY:STEVEN GERSTLER, M.D.LMcc: REPORT APPROVED DATE AND TIME: 3/12/2014 2:16:00 PM

MRI CARDIAC FOR MORPHOLOGY and FUNCTION WO/W ***Exam Date: 03/12/2014I was contacted regarding the terminology in this report. There was concern that the term ischemia implied a reversible component.In this report, the term ischemia can be replaced with infarction.REPORT READ BY:STEVEN GERSTLER, M.D.REPORT ELECTRONICALLY SIGNED BY:STEVEN GERSTLER, M.D.SGcc: REPORT APPROVED DATE AND TIME: 3/13/2014 4:51:00 PM

BMH-ACS would like to have their studies read by Memorial radiologists whenever possible. If not possible, the ordering cardiologist should be called and given the option of postponing the reading, the test or geting the reading from another radiologist.Dr Jones retired.

The CardioPhiles

Reavscularization of the LAD?

S/p extensive anteroapical MI with late presentation. TO pLAD, 70% mRCA. Complicated by acute left middle cerebral artery infarct s/p intra-arterial tPA. CMR done to determine if revascularization of LAD was needed.

Non-viable vs. Ischemic viable myocardium

BMH-ACS would like to have their studies read by Memorial radiologists whenever possible. If not possible, the ordering cardiologist should be called and given the option of postponing the reading, the test or geting the reading from another radiologist.Dr Jones retired.