63 year old man s/p CABG. Assess for ischemia, viability.MEDICATIONS: Regadenoson and aminophylline per protocol Status post CABG. First Pass PerfusionDuring hyperemia, subendocardial perfusion defects are present in the basal inferoseptal, inferior, and inferolateral wall as well as the mid inferoseptal and inferior walls of the LV.Viability/ Myocardial ScarThere is focal full thickness delayed hyperenhancement within the basal inferior and mid inferoseptal walls of the LV, consistent with previous myocardial infarct. A focal area of apparent delayed hyperenhancement with the basal/mid lateral wall may be artifactual.Left Ventricle There is moderate hypokinesis of the inferior wall of the basal and mid LV.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal.Right AtriumThe right atrium is moderately enlarged.Aortic ValveMild aortic regurgitation.Mitral ValveMild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveModerate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall scattered pulmonary micronodules. Indeterminate T2 hyperintense hepatic lesion better characterized on previous MRI of the liver. 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, subendocardial perfusion defects are present in the basal inferoseptal, inferior, and inferolateral wall as well as the mid inferoseptal and inferior walls of the LV.2. There is focal full thickness delayed hyperenhancement within the basal inferior and mid inferoseptal walls of the LV, consistent with previous myocardial infarct.3. Moderate tricuspid regurgitation. Mild aortic and mitral regurgitation.LV and RV function will be added as a separate addendum once those measurements have been performed.