12 year male with history of coarctation s/p stent and recent angioplasty who presents for stress test to evaluate for ischemia in light of an anomalous left coronary arteryMEDICATIONS: Singular, Zyrtec First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim imaging artifact is noted during hyperemia. 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 67%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 149 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 49 ml (normal range 47+/-19), the LV mass index is 61 g/m2, and the LV mass is 100 g. There are no regional wall motion abnormalities present. A spontaneously closed muscular ventricular septal defect is noted. Coronary ArteriesThere is an anomalous origin of the left coronary artery which arises from the right coronary sinus and travels retroaortic to the take its normal course and bifurcates into the left circumflex artery and left anterior descending. The right coronary artery has a normal origin. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 42 ml/m2 (normal range 82+/-16), the RVEDV is 70 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 124 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. The descending thoracic aorta has a stent in it and does not allow visualization of the aortic lumen. 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. Anomalous origin of the left main coronary artery with a retroaortic course. 2. No perfusion defects/ "ischemia" present during hyperemia.3. No prior myocardial infarction. The entire myocardium is viable.4. Normal LV size and systolic function (LVEF 67%) without regional wall motion abnormalities.5. Normal RV size and systolic function (RVEF 64%).6. A spontaneously closed muscular ventricular septal defect is noted.7. A stent is noted in the descending thoracic aorta. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.