Myocardial perfusion after coronary artery bypass surgery. A study using ectomographic myocardial scintigraphy and adenosine provocation.
A study was conducted to determine the time dependency of myocardial perfusion improvement after coronary artery bypass graft (CABG) surgery. Seventeen 3-vessel diseased patients (16 male, 1 female) scheduled for CABG surgery from a cardiac surgical and intensive-care unit were examined. Ten of the 17 patients returned for examination after 1 year. A titrated adenosine infusion was used to expose reversible ischemia. Tc99m-sestamibi was injected at rest and at maximum adenosine infusion rate, and isotope distribution was determined using ectomographic myocardial scintigraphy. Visually scored percent isotope uptake defect size and percent uptake reduction were assessed. It was found that resting isotope uptake defects were unchanged 1 h after surgery, increased in severity after 1 week, and after 1 year were 24% less than the preoperative scores (p < 0.01) and 55% less than after 1 week (p < 0.001). It was found that adenosine infusion induced a 57% increase in average defect score preoperatively (p < 0.001) but no increase postoperatively. No differences were seen between regions supplied by arterial or venous grafts. Isotope uptake defects increased between 1 h and 1 week after CABG surgery, and after 1 year the scores were less than those recorded preoperatively and after 1 week. Adenosine-induced reversible isotope uptake changes seen preoperatively were eliminated postoperatively in all vessel regions.
Anderson
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Department of Cardiothoracic Anesthetics, Karolinska Hospital, Stockholm, Sweden. russell.anderson@kirurgi.ki.se
Bone
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Dale
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Lindström
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Owall
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Brodin
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D000241:Adenosine / Q000494:pharmacology; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology; D015425:Myocardial Reperfusion / Q000009:adverse effects*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis; D011300:Preoperative Care; D017256:Technetium Tc 99m Sestamibi; D014055:Tomography, Emission-Computed
D017256:Technetium Tc 99m Sestamibi; D000241:Adenosine