63 year old man s/p heart transplant (with graft vasculopathy s/p PCI), Gerbode defect, referred for stress perfusion imaging.MEDICATIONS: ASA, amlodipine, lipitor, plavix, lisinopril, prograf, cellcept. First Pass PerfusionDuring hyperemia, there is no perfusion defects consistent with ischemia. There are fixed perfusion defects in the basal inferoseptum and basal to apical inferior wall in areas noted to have scar from prior myocardial infarctions.Viability/ Myocardial ScarThere is subendocardial late gadolinium enhancement noted in the basal to mid inferior and inferoseptal walls. It is in a pattern suggestive of prior myocardial infarction, and occupies greater than 50% of the myocardial thickness, indicating low likelihood of viability. The remaining myocardium is viable.Left VentricleThe left ventricle is normal in size with mild to moderately reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 78 ml/m2 (normal range: 74+/-15), the LVEDV is 166 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 99 ml (normal range 47+/-19), the LV mass index is 51 g/m2, and the LV mass is 109 g. There is dyskinesis and thinning of the basal to mid inferior and inferoseptal walls. There is a Gerbode ventricular septal defect (LVOT-RA shunt) with left to right flow. Qp/Qs is 1.3. Left AtriumThe left atrium is enlarged consistent with transplant morphology.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 57 ml/m2 (normal range 82+/-16), the RVEDV is 122 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 53 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 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. There is mild late gadolinium enhancement of the pericardium. 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. During hyperemia, there is no perfusion defects consistent with ischemia. There are fixed perfusion defects in the basal inferoseptum and basal to apical inferior wall in areas noted to have scar from prior myocardial infarctions.2. There is a transmural myocardial infarction involving the basal to mid inferoseptum and inferior walls. These segments have low likelihood of viability. The remaining myocardium is free of myocardial infarction and is viable.3. The left ventricle is normal in size with mild to moderately reduced systolic function. The overall LV ejection fraction is 40%. There is dyskinesis and thinning of the basal to mid inferoseptal and inferior walls. 4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%.5. There is a Gerbode ventricular septal defect (LVOT-RA shunt) with left to right flow. Qp/Qs is 1.3. 6. There is mild late gadolinium enhancement of the pericardium, which could be sequelae from a prior episode of pericarditis. It can not be determined from this study whether this finding is associated with constrictive physiology.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.