65 year old male status post cardiac transplant, referred for vasodilator stress CMRI to evaluate for transplant vasculopathy.MEDICATIONS: cellcept, fosamax, Lasix, Norvasc, Prograf, Sildenafil, Fenofibric Acid, Humolog, Januvia, Lovaza. First Pass PerfusionDuring hyperemia, no perfusion defects were present. 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. There is mild basal anteroseptal hypertrophy at end diastole, maximum thickness of 14mm. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 56 ml/m2 (normal range: 74+/-15), the LVEDV is 110 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 45 ml (normal range 47+/-19), the LV mass index is 64 g/m2, and the LV mass is 127 g. There are no regional wall motion abnormalities present. No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Transplant morphology noted. 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 71 ml/m2 (normal range 82+/-16), the RVEDV is 141 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 71 ml (normal range 54+/-17).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.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 pericardial effusion.Extracardiac FindingsEnlarge right and left axillary lymph nodes. Multiple enlarged mediastinal lymph nodes. In this clinical setting, post transplant lymphoproliferative disease is suspected. Further evaluation with thoracic CT is recommended.
1. No perfusion defects/ "ischemia" present during hyperemia.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. Multiple enlarged axillary and mediastinal lymph nodes suggestive of post-transplant lymphoproliferative disorder. Further evaluation with thoracic CT is recommended. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.