59 year old woman with history of acute aortic dissection s/p ascending aortic graft repair. Patient with recent syncopal episode and atypical chest pain referred to evaluate aorta and rule out ischemia.MEDICATIONS: aspirin, atorvastatin, carvedilol, and bumex 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 severely dilated with normal systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 111 ml/m2 (normal range: 65+/-11), the LVEDV is 196 ml (normal range 109+/-23), the LV end systolic volume index is 37 ml/m2 (normal range 18+/-5), the LVESV is 66 ml (normal range 31+/-10), the LV mass index is 111 g/m2, and the LV mass is 193 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 157 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 77 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is mild to moderate 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 dilated. There is a graft in the ascending aorta. The proximal portion of the aortic arch is dilated. No thoracic aortic dissection noted. Sinus of Valsalva: 47 x 48 mmSinotubular junction: 35 x 35 mmArch (proximal): 43 x 38 mmArch (mid): 35 x 36 mmDescending aorta: 31 x 30 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is dilated (proximally 40mm, distally 46mm). The LPA and RPA proximally were within normal limits. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Severe LV dilation with normal systolic function (LVEF 66%).4. Normal RV size and systolic function (RVEF 51%).5. The aortic root is dilated (measurements as above). Ascending aorta repair/ graft noted without focal aneurysm or obvious complication at the anastomoses sites. 6. Mild to moderate aortic regurgitation7. There is significant dilation of the main pulmonary artery. 