58 year old woman with history of AVR who has dyspnea on exertion and palpitations. She is referred to rule out ischemia. First Pass PerfusionDuring hyperemia, no perfusion defects were present.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 and systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 60 ml/m2 (normal range: 65+/-11), the LVEDV is 95 ml (normal range 109+/-23), the LV end systolic volume index is 19 ml/m2 (normal range 18+/-5), the LVESV is 31 ml (normal range 31+/-10), the LV mass index is 58 g/m2, and the LV mass is 92 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 50 ml/m2 (normal range 69+/-14), the RVEDV is 79 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 33 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveAn aortic valve replacement is noted. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 68%).4. Normal RV size and systolic function (RVEF 59%).5. Aortic valve replacement is noted. 