66 year old man referred to evaluate aorta, aortic valve, and to rule out ischemia as a cause of his shortness of breath and chest pain. First Pass PerfusionDuring hyperemia, there is a nearly circumferential perfusion defect involving the basal, mid-ventricular, and apical slices. During resting conditions, no perfusion defect is noted. These findings are consistent with either multivessel coronary artery disease or microvascular dysfunction. 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 and systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 66 ml/m2 (normal range: 74+/-15), the LVEDV is 150 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 62 ml (normal range 47+/-19), the LV mass index is 56 g/m2, and the LV mass is 131 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 173 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 87 ml (normal range 54+/-17).Right AtriumThe right atrium is moderate dilated.Aortic ValveThe aortic valve is anatomically trileaflet; however, the right and non-coronary cusps are partially fused together and heavily calcified. There is evidence of poor leaflet excursion and flow acceleration through the aortic valve consistent, with aortic valve stenosis. Correlation with echocardiography is suggested to better quantify the severity. There is mild aortic regurgitation (RF 5%).Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trivial pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. No thoracic aortic aneurysm, dissection, or coarctation is noted. Sinus of Valsalva: 36x37x38mmST Junction: 32x34mmAscending Aorta: 33x34mmPulmonary 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 FindingsBilateral renal cysts are 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. There is a global circumferential perfusion defect present during stress consistent with either multivessel coronary disease or extensive microvascular disease.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 59%).4. Normal RV size and systolic function (RVEF 50%).5. The aortic valve is anatomically trileaflet; however, the right and non-coronary cusps are partially fused together and heavily calcified. There is evidence of poor leaflet excursion and flow acceleration through the aortic valve consistent, with aortic valve stenosis. Correlation with echocardiography is suggested to better quantify the severity. 6. No evidence of aortic dilation, dissection, or coarctation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.