MRI CARDIAC Indication: To check viability. H/o LAD -CTO with PTCA and 2 DES to LAD Technique: The study was performed on Philips 3T scanner with high resolution body coil. Post processing done in the native software. 2D axial FIESTA, dynamic cine imaging in 2, 3 and 4 chambers views were obtained. Cardiac wall motion analysis done on SA cine images. Post gadolinium scan for delayed enhancement was done using PSIR sequences. Flow analysis was done. Post contrast images were obtained using 16ml i.v contrast. No immediate post contrast reaction is noted. eGFR-61ml/min. Results: General: Cardiac chambers demonstrate normal atrio-ventricular and ventricular atrial concordance. Normal systemic and pulmonary venous return. ave Do, se thiand not ar seor ans at apal vero-septal at midt ventricular and Thinned out segments shows hypokinesia. • Maximum wall thickness measures-4mm at mid-ventricular level. Wide neck true LV aneurysm formation is noted. • Rest of the LV segments have preserved contractility and wall thickness. Normal with ED internal diameter measures 48mm • Prominent trabeculae/ non-compacted myocardium is also noted along latera aspect of LV at mid-ventricular level No evidence of LV apical thrombus on cine or LGE images. Quantitative LV functional values obtained excluding papillary muscles. RV: Show normal size. RVED internal diameter measures 30 mm. Ventricular wall thickness is normal. Functional calculation may be sub optimal due to septal dyssynchrony. LVEF: 29% RVEF: 38% LV stroke volume: 78.3 ml RV stroke volume: 35.8mll LVED volume/ BSA: 118.9 ml/m? RVED volume/ BSA: 40.8 ml/m? LVED mass: 140.5 gr Cardiac output: 6.5L/min Late gadolinium enhancement: •Near complete subendocardial & transmural LGE noted in anterior, septal an nferior segments at apex • >50% LGE is also noted anterior, antero-septal, infero-septal at mid-ventricular No other area of abnormal LGE. No subepicardial enhancement. Atria: normal. Valves: Normal mitral annulus. Gross morphology of the aortic and pulmonary valves appear unremarkable. Great vessels: Thoracic aorta - normal. Qp:Qs=0.92 Pericardium: No pericardial effusion or thickening. No enhancement. T1 & T2 Mapping- T1 native = 1385+/- 41ms (normal) & 1485+/-39ms (thinned out myocardium) T1 enhanced = 472+/-30 ms (normal) & 357 +1-39 ms (thinned out myocardium) ECV = 28.64% (normal) 47.79% (thinned out myocardium) T2 value = 51 ms CONCLUSION: MR Cardiac study reveals Diffuse thinned LV wall with aneurysm formation - non-viable LAD territory (6 out of 16 segments are non-viable). This above detail is from MRI heart can you give brif conclusion of above report

What treatment options are recommended for LAD-CTO with low EF?