Impression:
Moderate-to-severe ischemia in anterior septum, anterior wall, and lateral wall from base to apex, including the apex (small lines) (13/25 segments, more than 50% of the total myocardial volume).
The ischemia involves both LAD and LCX territories, strongly suggestive of left main disease.
Mild increased RV uptake at rest, marked increase in RV uptake during stress.
Coronary Angiography:
LM - at least 40% stenosis in a very thin LM
Otherwise diffuse CAD
Echocardiography:
Left ventricular cavity size is normal with preserved systolic function
Left ventricular ejection fraction - 60%
Right ventricular enlargement with preserved right heart function
Follow up:
The patient subsequently underwent LM single-vessel bypass (unusual for heart transplant patients)
Myocardial perfusion study three months after bypass was within normal limits
Comments:
It is not the degree of stenosis that determines the functional significance of any given stenosis -- but the flow capacity of the stenotics. This principle is clearly demonstrated in this patient.
There is evidence of reinnervation (chronotrope response and chest pain) 10 years after transplantation.
