78-year-old male with a history of hypertension, hyperlipidemia, paroxysmal nocturnal dyspnea, coronary artery disease with PCI of ostial right coronary artery, now with ostial left anterior descending disease. MRI evaluation prior to PCI of ostial LAD versus TECAB of LAD.MEDICATIONS: Aspirin, clopidogrel, isosorbide mononitrate, losartan, metoprolol, simvastatin. 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 with normal systolic function. The overall LV ejection fraction is 73%, the LV end diastolic volume index is 57 ml/m2 (normal range: 74+/-15), the LVEDV is 100 ml (normal range 142+/-34), the LV end systolic volume index is 16 ml/m2 (normal range 25+/-9), the LVESV is 28 ml (normal range 47+/-19), the LV mass index is 33 g/m2, and the LV mass is 58 g. There are no regional wall motion abnormalities present. Stent artifact is noted in the mid right coronary artery.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 112 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 49 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. There is mild 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 obvious pericardial disease.Extracardiac FindingsHepatic cyst is 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. 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 73%).4. Normal RV size and systolic function (RVEF 56%).5. Mild mitral regurgitation6. Moderate left atrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.