Preoperative assessment of congestive liver dysfunction using technetium-99 m galactosyl human serum albumin liver scintigraphy in patients with severe valvular heart disease.
BACKGROUND
Severe valvular heart disease is often complicated by congestive liver dysfunction, which greatly compromises the operative results. We evaluated congestive liver dysfunction by a novel approach using technetium-99 m galactosyl human serum albumin ((99m)Tc-GSA) with liver scintigraphy.


METHODS
Between 1998 and 2004, we performed scintigraphy accompanied by (99m)Tc-GSA in 28 patients who had valvular heart disease with moderate-to-severe tricuspid regurgitation and who showed symptoms of right heart failure. Based on the results, we calculated a receptor index (LHL15) and an index of blood clearance (HH15) and assessed the correlation between these factors and postoperative liver dysfunction, defined as the maximum serum total bilirubin level (max T-bil) as >2.0 mg/dl.


RESULTS
Nineteen patients, including four who died in hospital, had postoperative liver dysfunction. The level of HH15 was significantly higher and the level of cholinesterase was significantly lower (P < 0.05) in patients with liver dysfunction than in those without liver dysfunction. Multivariate logistic regression analysis identified HH15 as the most sensitive indicator of postoperative hepatic dysfunction.


CONCLUSIONS
The level of HH15 calculated using scintigraphy with (99m)Tc-GSA is a clinically useful predictor of postoperative liver dysfunction in patients with severe valvular disease.
Nishi
Hiroyuki
H
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Takahashi
Toshiki
T
Matsumiya
Goro
G
Takano
Hiroshi
H
Ichikawa
Hajime
H
Miyagawa
Shigeru
S
Sawa
Yoshiki
Y
D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D018826:CD13 Antigens / Q000097:blood; D002802:Cholinesterases / Q000097:blood; D004396:Coloring Agents / Q000493:pharmacokinetics; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D043384:Glutamyl Aminopeptidase / Q000097:blood; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D006349:Heart Valve Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics; D007275:Injections, Intravenous; D008107:Liver Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D013668:Technetium Tc 99m Aggregated Albumin / Q000008:administration & dosage; D016284:Technetium Tc 99m Pentetate / Q000008:administration & dosage; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology
D004396:Coloring Agents; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C070561:technetium Tc 99m DTPA-galactosyl-human serum albumin; D002802:Cholinesterases; D018826:CD13 Antigens; D043384:Glutamyl Aminopeptidase; D007208:Indocyanine Green; D001663:Bilirubin; D016284:Technetium Tc 99m Pentetate