69 year old man who underwent heart and kidney transplant in 2005 now returning for surveillance for allograft vasculopathy with CMR stress perfusion imaging. MEDICATIONS: carvedilol, cellcept, lasix, hydralazine, lantus, omega 3 fatty acid, prednisone, tacrolimus, simvastatin, synthroid First Pass PerfusionDuring hyperemia, perfusion defects were present in the basal anteroseptum and inferoseptum, mid anterolateral, inferolateral, inferior, and inferoseptal walls. This pattern is similar to the observed perfusion defects from the previous study of 2014.Viability/ Myocardial ScarThere are foci of mild atypical heterogenous signal in the myocardium which are not consistent with ischemia. This could represent a subtle fibrotic, inflammatory or infiltrative process. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 178 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 71 ml (normal range 47+/-19), the LV mass index is 93 g/m2, and the LV mass is 185 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is consistent with prior transplant. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 89 ml/m2 (normal range 82+/-16), the RVEDV is 178 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 77 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with prior transplant.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 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. Perfusion defects seen in a similar distribution to the previous study of 2014. This may represent microvascular disease given the clinical history of no obstructive disease by angiography. 2. There is a mild atypical pattern of heterogenous signal seen on the delayed enhancement images which is not consistent with ischemia. 3. Normal LV size and systolic function (LVEF 60%), stable from the previous study.4. Normal RV size with reduced systolic function (RVEF 46%), stable from the previous study.