case_images: PMC4857340_01
case_images: Thallium/MIBI myocardial perfusion test with dobutamine performed prior to TMR shows a moderately sized perfusion defect in the mid-anteroseptum which was 50% fixed and 50% reversible post stress. The perfusion defect with stress (dobutamine) in (a) and (c) is considerably larger compared to (b) and (d). A quantity of 3.6 mCi of Thallium 201 was used. SPECT imaging was then performed. The patient was then administered dobutamine IV followed by 31.5 mCi of Tc-99m MIBI. SPECT and gated SPECT imaging were then performed. Patient exercised to a maximum heart rate of 127: (a) Bull's eye view of the heart during stress. (b) Bull's eye view of the heart during rest. (c) Vertical long axis view of the heart during stress. (d) Vertical long axis view of the heart during rest.. TMR: transmyocardial revascularization; SPECT: single-photon emission computed tomography; Tc-99m: Technetium-99m.
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case_images: Normal perfusion was noted in the remainder of the left ventricle (Figure 1(a)-(d)).
case_images: Cardiac catheterization performed in June 2009 prior to undergoing TMR revealed a coronary flow reserve of 1.4 in the left anterior descending coronary artery.. TMR: transmyocardial revascularization.
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case_images: In June 2009, the patient underwent another cardiac catheterization that included an assessment of coronary flow reserve (CFR) (Figures 2 and 3).
case_images: Cardiac catheterization performed in June 2009 prior to undergoing TMR revealed a coronary flow reserve of 2.7 in the right coronary artery.. TMR: transmyocardial revascularization.
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case_images: In June 2009, the patient underwent another cardiac catheterization that included an assessment of coronary flow reserve (CFR) (Figures 2 and 3).
case_images: Sestamibi treadmill stress test performed in December 2009, approximately 3 months after TMR, showed normal myocardial perfusion post stress. An apical thinning artifact is noted. The perfusion image on the left was obtained at rest, and the image on the right was obtained post stress. A quantity of 8.6 mCi of Tc-99m sestamibi was used. Patient exercised for 10 min and 11 s to a heart rate 137 (84% maximum heart rate). After IV administration of 27.34 mCi of Tc-99m sestamibi at peak exercise, post-stress images were obtained: (a) normal perfusion at rest and (b) normal perfusion post stress.. TMR: transmyocardial revascularization; IV: intravenous; Tc-99m: Technetium-99m.
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case_images: A sestamibi treadmill stress test revealed normal myocardial perfusion with no evidence of ischemia or scar, LVEF of 33% with global left ventricular hypokinesis (Figure 4(a) and (b)).
case_images: Sestamibi treadmill stress test performed in December 2010, approximately 15 months after TMR, showed normal myocardial perfusion post stress. An apical thinning artifact is noted. The perfusion image on the left was obtained at rest, and the image on the right was obtained post stress. A quantity of 8.6 mCi of Tc-99m sestamibi was used. Patient exercised for 8 min and 25 s to a heart rate of 134 (82% maximum heart rate). After IV administration of 22.51 mCi of Tc-99m sestamibi at peak exercise, post-stress images were obtained: (a) normal perfusion at rest and (b) normal perfusion post stress.. TMR: transmyocardial revascularization; IV: intravenous; Tc-99m: Technetium-99m.
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case_images: She underwent an additional sestamibi treadmill stress test in December 2010 which again showed no evidence of ischemia or scar, LVEF 34%, with global left ventricular hypokinesis (Figure 5(a) and (b)).