Non-viable LAD infarct
Non-viable LAD infarct
1.Fig 1. 4CH SSFP: Dilated left ventricle and left atrium, with myocardial thinning in apex.
2.Fig 2. Rest perfusion SA image: Rest perfusion deficit (arrows) in anteroseptal and inferoseptal mid-ventricle.
3.Fig 3,4,5. 2 CH, 4CH and 3CH PSIR: Transmural LGE (late gadolinium enhancement) involving mid-ventricular interventricular septum and anterior wall and apex, with myocardial wall thinning and aneurysmal dilatation of apex.
Fig 6,7. SA PSIR: Transmural LGE (late gadolinium enhancement) involving mid-ventricular interventricular septum, mid-ventricular anterior wall and apex, with myocardial wall thinning.
Fig 8. Calculation of LV function shows dilated left ventricle with reduced ejection fraction: LVEF: 31% and LVEDV: 268 ml
DIAGNOSIS:
Non-viable left ventricular apical and mid interventricular septal myocardium with transmural delayed gadolinium enhancement, and extending to involve basal septum, with wall thinning and aneurysmal dilatation of apex.
DISCUSSION:
Differentiation of viable and non-viable myocardium
Complications of non-viable (infarcted) myocardium:
1.Ventricular free wall rupture.
2.Ventricular septal rupture.
3.Mitral valve regurgitation.
4.post-myocardial infarction pericarditis.
5.Left ventricular aneurysm.
REFERENCES:
- Elfigih IA, Henein MY. Non-invasive imaging in detecting myocardial viability: Myocardial function versus perfusion. IJC Heart & Vasculature. 2014 Dec 1;5:51-6.
- Montrief T, Davis WT, Koyfman A, Long B. Mechanical, inflammatory, and embolic complications of myocardial infarction: An emergency medicine review. The American journal of emergency medicine. 2019 Jun 1;37(6):1175-83.
Case contributed by:
DNB, Fellowship Cardiothoracic Imaging (USA)
Lead Cardiothoracic Imaging
Manipal Hospitals Radiology Group.
Unit coordinator, Whitefield
MD
Senior resident and cross-sectional fellow
Manipal Hospitals Radiology Group.
