62 year old woman with anomalous left main coronary artery referred to evaluate for ischemia and viability to determine potential benefit of surgery. First Pass PerfusionDuring hyperemia and during resting conditions, nearly circumferential perfusion defects are noted in the basal and mid ventricular slices. Although this finding would typically represent a dark rim artifact, given the patient's known anomalous left main coronary artery, subtle global hypokinesis, and evidence of small myocardial infarction, the possibility that it represents mild resting and hyperemic ischemia can not be excluded. Viability/ Myocardial ScarThere is a non-transmural myocardial infarction (i.e. late gadolinium enhancement) involving the basal anterolateral wall. This segment has an intermediate probability of viability. The remainder of the entire myocardium is viableLeft VentricleThe left ventricle is normal in size with mildly reduced systolic function. There is mild global hypokinesis with slightly worse hypokinesis of the basal anterolateral wall. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 88 ml/m2 (normal range: 65+/-11), the LVEDV is 153 ml (normal range 109+/-23), the LV end systolic volume index is 46 ml/m2 (normal range 18+/-5), the LVESV is 81 ml (normal range 31+/-10), the LV mass index is 35 g/m2, and the LV mass is 60 g. 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 55%, the RV end diastolic volume index is 64 ml/m2 (normal range 69+/-14), the RVEDV is 112 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 50 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant 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 normal brachiocephalic branching pattern. Tortuous thoracic descending aorta. 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 FindingsThis 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 and during resting conditions, nearly circumferential perfusion defects are noted in the basal and mid ventricular slices. Although this finding would typically represent a dark rim artifact, given the patient's known anomalous left main coronary artery, subtle global hypokinesis, and evidence of small myocardial infarction, the possibility that it represents mild resting and hyperemic ischemia can not be excluded. 2. There is a non-transmural myocardial infarction (i.e. late gadolinium enhancement) involving the basal anterolateral wall. This segment has an intermediate probability of viability. The remainder of the entire myocardium is viable3. The left ventricle is normal in size with mildly reduced systolic function (LVEF 48%). There is mild global hypokinesis with slightly worse hypokinesis of the basal anterolateral wall. 4. Normal RV size and systolic function (RVEF 55%).