65 year old man who is s/p heart transplant and referred for evaluation of transplant arteriopathy. First Pass PerfusionDuring hyperemia, there is a non-transmural perfusion defect which involves the mid and apical septum, apical inferior, and apical lateral wall. The overall ischemia score is 4 out of 32 and 12% of the myocardium is ischemic. The ischemia is most likely in the the distal LAD territory. Viability/ Myocardial ScarThere was no of prior myocardial infarction. The entire myocardium is viable. However, there is a small, focal area of late gadolinium enhancement involving the basal inferior wall. The pattern is atypical for prior myocardial infarction and may be due to a prior episode of rejection. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVEDV is 138 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 60 ml (normal range 47+/-19), the LV mass index is 48 g/m2, and the LV mass is 90 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is dilated consistent with transplant history. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 80 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 75 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.Extracardiac FindingsSternal wires are noted. 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. There is mild ischemia in the usual distribution of the distal left anterior descending artery territory.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 57%). There is a very small amount of atypical late gadolinium enhancement in the basal inferior wall which represents underlying myocardial fibrosis, inflammation, and infiltration which is most likely due to an old episode of rejection. The pattern is atypical for prior myocardial infarction.4. Normal RV size and systolic function (RVEF 51%).