The Korean Journal of Nuclear Medicine (대한핵의학회지)

The Korean Society of Nuclear Medicine (대한핵의학회)
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Evaluation of Result of CABG by Comparison of Pre-and Post-operative Myocardial SPECT

관동맥우회로술 전후의 디피리다몰 부하/휴식 심근 SPECT를 이용한 수술 결과의 평가

  • Lee, Dong-Soo (Department of Nuclear Medicine, Seoul National University Hospital) ;
  • Lee, Won-Woo (Department of Nuclear Medicine, Seoul National University Hospital) ;
  • Kang, Keon-Wook (Department of Nuclear Medicine, Seoul National University Hospital) ;
  • Hyun, In-Young (Department of Nuclear Medicine, Seoul National University Hospital) ;
  • Kim, Ki-Bong (Department of Thoracic Surgery, Seoul National University Hospital) ;
  • Chung, June-Key (Department of Nuclear Medicine, Seoul National University Hospital) ;
  • Lee, Myung-Chul (Department of Nuclear Medicine, Seoul National University Hospital) ;
  • Koh, Chang-Soon (Department of Nuclear Medicine, Seoul National University Hospital)
  • 이동수 (서울대학교병원 핵의학과) ;
  • 이원우 (서울대학교병원 핵의학과) ;
  • 강건욱 (서울대학교병원 핵의학과) ;
  • 현인영 (서울대학교병원 핵의학과) ;
  • 김기봉 (서울대학교병원 흉부외과) ;
  • 정준기 (서울대학교병원 핵의학과) ;
  • 이명철 (서울대학교병원 핵의학과) ;
  • 고창순 (서울대학교병원 핵의학과)
  • Published : 1996.03.25
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Abstract

Coronary angiography should be performed to verify the patency of bypass graft if coronary artery disease is said to be surgically corrected. Rest/stress myocardial SPECT could be used as a noninvasive alternative to prove patency of bypass graft and functional significance of graft patency by showing improvement of rest perfusion and perfusion reserve after operation. We evaluated the outcome of coronary artery bypass graft surgery by comparing rest/dipyridamole-stress myocardial SPECT before and after operation. Myocardial SPECT were performed $19{\pm}23$ days before and $108{\pm}19$ days after operation in 44 patients(M:F=25:19). Segmental perfusion were scored with 0(normal) to 3(defect) independently for each image set of rest and stress. Perfusion scores were compared between pre and postoperative images. Rest/stress images of pre and post-operative SPECT were compared in paired sets. Postoperative change of perfusion was determined as no change, improvement or aggravation for each artery territory. Postoperative outcome of patients were analyzed. Overall, 74%(158 segments) of 215 segments which had perfusion decrease before operation showed improvement. Among 60 artery territories, 37 territories(62%) improved. Among 42 patients with perfusion decrease in preoperative SPECT, 21 patients(47%) improved after operation. Severe persistent defects improved in 43%(6/14). We concluded that bypass surgery improved myocardial perfusion in dipyridamole stress induced or persistent decrease and that rest/stress myocardial SPECT could be used as a guide for which artery should be operated.

디피리다몰부하 및 휴식기 심근 SPECT를 통해 수술결과를 평가하였다. 수술전 관류감소를 보이는 분절들의 74%에서 심근관류가 호전되었으며 중증 지속적 관류결손을 보였던 분절도 일부(43%) 수술후 관류가 호전되었다. 관상동맥영역별로는 62%의 영역이 수술후 관류가 호전되었으며, 환자예를 기준으로 하면 수술환자 47%가 수술후 심근관류가 호전되었다. 수술전에 정상이었던 관류가 악화된 예와 수술전 관류보다 나빠진 관류소견을 보이는 예가 있었다. 수술대상 관상동맥을 결정하는데 수술전 부하/심근 SPECT를 참고하여야 할 것인지 조사하여야 한다고 생각하였다.

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