71 year old man with CAD s/p CABG in 1998 (LIMA-LAD, SVG-D1), with recent PCI to SVG in 11/15 and again in 2/16 for ISR, referred fo revaluation of chest pain. MEDICATIONS: ASA, PLavix, Cilostozol, lisinopril, metoprolol First Pass PerfusionDuring hyperemia, there is a perfusion defect in the basal anterior wall and antero-lateral wall. In the mid-ventricle has a perfusion defect involving the inferoseptum, anteroseptum, anterior, and anterolateral walls. The overall ischemia score is 8 out of a possible 32. Approximately 25% of the myocardium is ischemic. 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 with normal systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 58 ml/m2 (normal range: 74+/-15), the LVEDV is 111 ml (normal range 142+/-34), the LV end systolic volume index is 18 ml/m2 (normal range 25+/-9), the LVESV is 34 ml (normal range 47+/-19), the LV mass index is 45 g/m2, and the LV mass is 85 g. There is mild concentric LVH. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 66 ml/m2 (normal range 82+/-16), the RVEDV is 126 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 54 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 mild to moderate mitral regurgitation. There is mild systolic anterior motion of the mitral valve leaflets causing mild flow acceleration in the left ventricular outflow tract. 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 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, there is a large perfusion defect as described above. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 69%).4. Normal RV size and systolic function (RVEF 57%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.