079H Left Main Calcification CTA Negative Angio

Echo 2018

Normal sized  left
ventricular cavity  with mildly depressed  left ventricular
systolic  function,  with an estimated  LVEF 45-50%.   Right
ventricle appears  normal in size  with mildly reduced  systolic
function.  The aortic  valve is thickened,  calcified  and
trileaflet with  mild restriction.  The AVA by planimetry  was 2.29
cm2 (would consider  obtaining a TTE  to assess AV more
completely). There  is mild central  AI. The mitral  valve leaflets
are normal with  mild MR. The tricuspid  valve is structurally
normal with trace  TR. Pulmonic valve  was not assessed.  Color flow
Doppler did not  reveal evidence for  intracardiac shunt.  There
were no masses,  thrombi or spontaneous  echo contrast  (“smoke”) in
the left or right  atria or their  appendages – normal  left atrial
appendage emptying  velocities (40-60  cm/s).  .


History of Dyspnea

CORONARY ANATOMY: There is no evidence for anomalous coronary
arteries. There is codominant coronary artery dominance.

LM: The left main coronary artery is short, with the LAD and LCx
branching off rather proximally. There are coarse calcifications
within the LM and there is a suggestion of a hemodynamically
significant lesion at its origin.

77M LM calcification and concern for hemodynamically significant lesion on CTA but neg cath
77M LM calcification and concern for hemodynamically significant lesion on CTA but neg cath
77M LM calcification and concern for hemodynamically significant lesion on CTA but neg cath


LAD: There are extensive coronary artery calcinations throughout theLAD, limiting evaluation.

LAD Calcifications

LCx: Multiple within the left circumflex artery, with noted calcified
plaque but no occlusion identified. No significant proximal lesion
identified. Distally there is a prominent o’clock precluding optimal
visualization. 2 patent obtuse marginal (OM) branches are identified.
There is a branch that supplies the posterior left ventricle, which
is also supplied by the distal RCA.

RCA: The right coronary artery (RCA) has some calcified plaque with
no hemodynamically significant luminal narrowing, . The posterior
descending artery (PDA) originates from the right coronary artery.
The posterior left ventricular (PLV) branches originate from the RCA.

CALCIUM SCORE: The observed Agatston Calcium Score of 1112.62 is at percentile 84 % for subjects of the same age, gender, and race/ethnicity who are free of clinical cardiovascular disease and treated diabetes.

Calcium Score

The Agatston score for each vessel is as follows:
LM:247.16; LAD: 596.24; LCx:184.18; RCA: 85.04;

VALVES: Moderate to severe calcifications of the aortic valve and calcification of the anterior leaflet of the mitral valve

Calcification of the Aortic VAlve
Calcification of the mitral valve

Cardiac Cath

Stable Angina
Aortic Valve Disease

Mild nonobstructive coronary atherosclerosis

Right Dominant
Left Main: Normal
Left Anterior Descending: Minimal luminal irregularities
Left Circ: Normal
RCA: Normal