76 year old man with CAD (recent PCI to mLAD), thoracic aorta repair referred for evaluation of underlying ischemia.MEDICATIONS: ASA, Plavix, losartan, Toprol xl, eliquis, aldactone First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere are 2 small areas of late gadolinium enhancement noted. One is in the apical lateral wall and the other in the basal inferolateral wall. They are mid-myocardial and in a pattern atypical for infarction. They may represent prior fibrosis, inflammation, or infiltration. There is no evidence of myocardial infarction and the entire myocardium is viable.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 64 ml/m2 (normal range: 74+/-15), the LVEDV is 159 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 56 ml (normal range 47+/-19), the LV mass index is 28 g/m2, and the LV mass is 70 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVEDV is 170 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 87 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation. Possible bicuspid aortic valve but only limited views available.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 mild to moderate tricuspid regurgitation.AortaThe aortic root is mildly dilated. Ascending aorta graft is noted. The proximal portion of the descending thoracic aorta is mildly dilated. 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 FindingsSternotomy wires are present. 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. There are 2 small areas of late gadolinium enhancement that are mid-myocardial and in a pattern atypical for infarction. They may represent prior fibrosis, inflammation, or infiltration. 3. Normal LV size and systolic function (LVEF 65%).4. Normal RV size and mildly reduced systolic function (RVEF 48%).5. Severe biatrial dilation.6. Possible bicuspid aortic valve but only limited views available.7. Mild to moderate tricuspid regurgitation.8. Sinus of Valsalva is mildly dilated. Ascending aorta graft is noted. The proximal portion of the descending thoracic aorta is mildly dilated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.