40 year old woman with history of orthotopic heart transplant in 2009, referred for annual evaluation of allograft vasculopathy. MEDICATIONS: Cellcept, Prograf, Pravastatin, Synthroid, Lyrica First Pass PerfusionDuring hyperemia, no definite perfusion defects were present. Apparent area of decreased enhancement during hyperemia and rest images within the interventricular septum in the mid and apical portions of the LV is likely artifactual.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 63%, the LV end diastolic volume index is 63 ml/m2 (normal range: 65+/-11), the LVEDV is 106 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 39 ml (normal range 31+/-10), the LV mass index is 18 g/m2, and the LV mass is 31 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 69%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 110 ml (normal range 110+/-24), the RV end systolic volume index is 20 ml/m2 (normal range 22+/-8), and the RVESV is 34 ml (normal range 35+/-13). Right AtriumThe right atrium is consistent with transplant. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveTrace 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 drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are present. Nonspecific renal hyperintense T2 lesions. 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 convincing evidence of perfusion defects/ "ischemia" present during hyperemia. Apparent area of decreased enhancement during hyperemia and rest images within the interventricular septum in the mid and apical portions of the LV is likely artifactual. Consider MRI follow-up imaging in 6 months for reevaluation.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 63%).4. Normal RV size and systolic function (RVEF 69%).