title: Preoperative assessment of congestive liver dysfunction using technetium-99 m galactosyl human serum albumin liver scintigraphy in patients with severe valvular heart disease.
abstract: 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.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishi
authors.forename: Toshiki
authors.initials: T
authors.lastname: Takahashi
authors.forename: Goro
authors.initials: G
authors.lastname: Matsumiya
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takano
authors.forename: Hajime
authors.initials: H
authors.lastname: Ichikawa
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyagawa
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
mesh_terms: 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
chemical_list: 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