Fig. 1

Patient with patent left internal mammary artery (LIMA)-to-left anterior descending coronary artery (LAD) and evidence of inducible perfusion defect in LIMA-native LAD territories. Short axis views from base to apex (left to right). Top row (a): First pass perfusion with adenosine stress, demonstrating qualitatively a perfusion defect in the basal to mid (but not apical) LAD territory. There is a second lateral perfusion defect. Middle row (b): Perfusion mapping showing quantitatively reduced peak myocardial blood flow (MBF) in these territories. (e.g. MBF in mid antero-septum is 0.85 ml/g/min, MBF in apical septum is 1.65 ml/g/min). c Bullseye plot of stress MBF in each American Heart Association (AHA) segment. Bottom row (d): Late gadolinium enhancement (LGE) images showing no infarction. e, f Coronary angiography demonstrating patent LIMA graft (e), anastomosis site (f) and good distal run off