74 year old woman with history of CAD s/p CABG in 2013, referred for further evaluation of inducible ischemia.MEDICATIONS: ASA, Lipitor, Coreg, Enalapril, Lasix, Nifedipine First Pass PerfusionDuring hyperemia, there were perfusion defects in the apical inferior, mid anterior and anterolateral and basal inferior walls.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. Mild left ventricular hypertrophy with a sigmoid septum. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 68 ml/m2 (normal range: 65+/-11), the LVEDV is 137 ml (normal range 109+/-23), the LV end systolic volume index is 24 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 39 g/m2, and the LV mass is 78 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. Lipomatous hypertrophy of the interatrial septum. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 155 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 70 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a pseudo-bovine brachiocephalic branching pattern. Mild atherosclerosis noted in thoracic aorta.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThyroid enlargement is noted. Sternal wires 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. During hyperemia, there were perfusion defects in the apical inferior, mid anterior and anterolateral walls, and the basal inferior walls.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 64%). Mild left ventricular hypertrophy.4. Normal RV size and systolic function (RVEF 55%).5. Mild dilation of the main pulmonary artery.6. Moderate biatrial dilation with lipomatous hypertrophy of the interatrial septum. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.