A 73 year old male with history of heart transplant, referred to stress cardiac MRI as a pre-operative evaluation for L1 fracture.MEDICATIONS: aspirin, ascorbic, acid, escitalopram, insulin, florinef, calcium, pravastatin, tacrolimus. Post-transplant changes noted.First Pass PerfusionDuring hyperemia, small perfusion defects were noted in the mid-septum and mid lateral wall.Viability/ Myocardial ScarThere is no definitive late gadolinium enhancement noted to suggest the presence of fibrosis, inflammation, or infiltration. There is no evidence of prior myocardial infarction. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 50 ml/m2 (normal range: 74+/-15), the LVEDV is 93 ml (normal range 142+/-34), the LV end systolic volume index is 17 ml/m2 (normal range 25+/-9), the LVESV is 33 ml (normal range 47+/-19), the LV mass index is 47 g/m2, and the LV mass is 87 g. There are no regional wall motion abnormalities present.Left AtriumThe left atrium has transplant morphology. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 53 ml/m2 (normal range 82+/-16), the RVEDV is 96 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 47 ml (normal range 54+/-17).Right AtriumThe right atrium has transplant morphology. 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 VeinsThe right upper pulmonary vein is not well visualized. There is additionally flow acceleration noted in the left atrium near the ostium of the right-sided pulmonary veins. These findings raise the possibility of a right pulmonary vein stenosis. 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 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. Two small perfusion defects are noted during hyperemia in the mid septum and mid lateral wall. Overall burden of ischemia is small and in fact the perfusion defects may be related to small vessel disease rather than epicardial disease given the somewhat non-coronary distribution of the defects. 2. There is no late gadolinium enhancement to suggest prior myocardial infarction, fibrosis, inflammation, or infiltration. This pattern is not compatible with prior myocardial infarction and is most probably compatible with his prior heart transplant. The rest of the myocardium is viable.3. Normal LV size and systolic function (LVEF 65%).4. Normal RV size and systolic function (RVEF 51%).5. The right upper pulmonary vein is not well visualized. There is additionally flow acceleration noted in the left atrium near the ostium of the right-sided pulmonary veins. These findings raise the possibility of a right pulmonary vein stenosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.