A 70 year old female with history of coronary artery disease, s/p coronary artery bypass (2000), hypertension, hyperlipidemia, chronic obstructive pulmonary disease, pulmonary hypertension.MEDICATIONS: aspirin, benazepril, carvedilol, clonazepam First Pass PerfusionDuring hyperemia, there are two distinct perfusion defects. The first is large and severe, involving the basal and mid infero-septum, inferior and inferolateral walls. The second is also large but mild and involves the basal to mid anterior wall and the mid anteroseptal and anterolateral walls. The overall ischemia score is 12 out of a possible 32. 38% of the LV is ischemic. Viability/ Myocardial ScarThere is a non-transmural myocardial infarction involving the basal to mid inferolateral wall. These segments have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is normal in size and systolic function. There is thinning and hypokinesis of the basal to mid inferior and inferolateral walls and the basal inferoseptum. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 84 ml/m2 (normal range: 65+/-11), the LVEDV is 132 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 44 g/m2, and the LV mass is 69 g. Left AtriumThe left atrium is mildly dilated (121ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 74 ml/m2 (normal range 69+/-14), the RVEDV is 117 ml (normal range 110+/-24), the RV end systolic volume index is 28 ml/m2 (normal range 22+/-8), and the RVESV is 44 ml (normal range 35+/-13). 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 severe mitral regurgitation with an eccentric jet. The posterior leaflet is tethered and the possibility of flail anterior leaflet can not be excluded.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 were 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 extensive myocardial ischemia in a multivessel coronary distribution with evidence of a large amount of myocardial viability.2. There is a small non-transmural myocardial infarction in the basal to mid inferolateral wall.3. Normal LV size and systolic function (LVEF 62%) with thinning and hypokinesis as described above.4. Normal RV size and systolic function (RVEF 62%).5. There is severe mitral regurgitation with a tethered posterior leaflet. Additionally, the possibility of a flail anterior mitral leaflet can not be excluded. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.