• The Korean Journal of Nuclear Medicine
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• v.23 no.1
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• pp.19-25
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• 1989

To assess the usefulness of myocardial SPECT imaging to detect post-myocardial infarction ventricular aneurysms, we analyzed the Technetium-99m MIBI myocardial SPECT images of 16 patients with anterior and/or apical infarction, 9 had the previously reported findings of failure of convergence of the left ventricular walls toward the apex on SPECT images and 8 of them also had ventricular aneurysms. The ventriculography of the 2 patients with mixed pattern revealed 1 case of ventricular aneurysm and 1 case without aneurysm. Among the remaining 5 pateints with converging pattern, none had ventricular aneurysm. Of the other 11 pateints with inferior and/or lateral wall infarction, 1 patient had ventricular aneurysm and the SPECT image couldn't detect the aneurysm. $Department of Internal Medicine, College of Medicine, Seoul National University$ myocardial SPECT images for the detection of ventricular aneurysm had a sensitivity of 90 %, a specificity of 88%, and an accuracy of 89%. Thus we could get the information about presence of ventricular aneurysm as well as the status of the myocardial perfusion from the Tc-99m MIBI myocardial SPECT images.

• The Korean Journal of Nuclear Medicine
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• v.38 no.3
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• pp.218-224
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• 2004

We compared rest perfusion PET with redistribution perfusion SPECT to investigate the concordant rate between PET and SPECT images and analyze the discordant pattern. Materials and Methods: Rest N-13 ammonia and F-18 FDG PET were performed on 18 patients with old myocardial infarction and left ventricular dysfunction whose dipyridamole - 4hr redistribution TI-201 SPECT showed one or more severe fixed defects. Regional perfusion and metabolism were evaluated visually and quantitatively with 5-segment myocardial model. Results: There were high concordant rate in uptake pattern (80/90 segments, 88.9%) and high correlation coefficient on quantitative analysis (R=0.81, p<0.001) between redistribution TI-201 SPECT and N-13 ammonia PET images. Nine of 18 patients had SPECT-PET concordant pattern (Group I). Ten segments (9 in inferior wall, 1 in apex) from the remaining 9 patients showed SPECT-PET discordant pattern with abnormal TI-201 defect and near normal N-13 ammonia uptake (Group II). The diastolic and systolic left ventricular dimensions were significantly increased in Group II compared to those of Group I. When attenuation uncorrected N-13 ammonia PET images were reconstructed in Group II, it resulted in PET images with severe inferior wall defects nearly identical to those seen in redistribution TI-201 SPECT images. Conclusion: Redistribution TI-201 SPECT images showed high concordant rate and correlation with rest N-13 ammonia PET images. Most of discordant segments had fixed thallium defects in inferior wall with nearly normal N-13 ammonia uptake, which may result from severe left ventricular dilatation and attenuation by the left hemidiaphragm and cardiac blood pool.

• The Korean Journal of Nuclear Medicine
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• v.17 no.2
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• pp.25-33
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• 1983

Left ventricular wall motion was observed with EKG gated cardiac blood pool scan in 71 various cardiac diseases and 10 normal controls to evaluate its diagnostic and clinical significance in them. 1) In the presence of left ventricular dysfunction, visual evaluation of the left ventricular wall motion was useful to determine whether it was due to localized or diffuse abnormalities. In cardiomyopathy, marked left ventricular dilatation and severe hypokinesia were noted. 2) In myocardial infarction, regional wall motion abnormalities well represented the location of infarcted areas in majority of cases. Patients with inferior wall infarction had smaller decrease of the left ventricular ejection fraction and wall motion grade than anterior or combined groups. In whom persistent left ventricular failure was present, wall motion analysis with gated cardiac scan provided valuable information for the detection of ventricular aneurysms. 3) Evaluation of the left ventricular wall motion and its grading provided a reliable estimate of the left ventricular function. In conclusion, visual evaluation of left ventricular wall motion and its grading provided valuable information for analyzing the characteristics of regional and global left ventricular dysfunction.

• Journal of Yeungnam Medical Science
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• v.29 no.2
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• pp.129-131
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• 2012

A 70-year-old male came to the emergency room of the authors' hospital because of sudden cardiac arrest due to inferior wall ST elevation myocardial infarction. His coronary angiography revealed multiple severe coronary spasms in his very long left anterior descending artery. After an injection of intracoronary nitroglycerine, his stenosis improved. The cardiac arrest relapsed, however, accompanied by ST elevation of the inferior leads, while the patient was on diltiazem and nitrate medication to prevent coronary spasm. Recovery was not achieved even with cardiac massage, intravenous injection of epinephrine and atropine, and intravenous infusion of nitroglycerine. The patient eventually recovered through high-dose nicorandil intravenous infusion without ST elevation of his inferior leads. Therefore, intravenous infusion of a high dose of nicorandil must be considered a treatment option for cardiac arrest caused by refractory coronary vasospasm.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1077-1082
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• 1997

To assess the early results, risk factors and optimal timing for coronary artery bypass graft surgery(CABG) after an acute myocardial infarction(AMI), we reviewed our 19 patients who underwent CABG within 30 days after AMI, between June 1994 and October 1996. This study excluded 1 patient whose diagnosis was AMI with ventricular septal rupture. 14 of the patients were male and 5 were female. Their ages ranged from 41 to 77 years(mean age, 60.6$\pm$ 10.4 years), and the amount of time between AMI and CABG ranged from 8 hours to 24 days(mean time, 10.6$\pm$6.4 days). There were 11 anteroseptal infarctions and 8 inferior wall infarctions. 11 patients had trsnsmural infarctions and 8 had subendocardial infarctions. Indications of operations were p imary revascularization and postinfarction angina. Three patients required preoperative intra-aortic balloon pump(IABP) support, and 4 additional patients required IABP to be separated from cardiopulmonary bypass. An average of 3.6 $\pm$ 0.6 vessels per patient were bypassed. The early mortality rate for these 19 patients was 5.3% and late mortality rate was 5.5%, 1-year and 2-year actuarial survival rates were 89.5% Univariate analysis of mortality showed that an ejection fraction less than 30% and intraopretative IABP supports were associated with risk factors(p value=0.018 and 0.015 respectively). Age, sex, time to CABG, emergency operations, types and locations of infarctions were not significant. Although our studies have weak p.oints in that there was only a small number of patients and the lack of long-term results, we could conclude that early myocardial revascularization is relatively safe after AMI for those individuals with an ejection fraction greater than 30%.

• The Korean Journal of Nuclear Medicine
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• v.30 no.1
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• pp.95-103
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• 1996

Reverse redistribution(RRD) refers to a perfusion defect that develops or becomes more evident on rest imaging compared with the stress imaging. This phenomenon was not uncommonly noted on myocardial perfusion single photon emission computed tomography (SPECT). However, the clinical significance and pathophysiological mechanism of RRD were unclear. The aim of this study was to evaluate the incidence and clinical significance of RRD on either dipyridamole T1-201 or Tc-99m MIBI myocardial perfusion SPECT. RRD was defined as ${\geq}10%$ decrease in relative T1-201 and Tc-99m MIBI uptakes on rest images compared to the stress images or as an appearance of new perfusion defects on rest images. It was observed in both T1-201 (44/463, 9.5%) and Tc-99m MIBI (124/999, 12.4%) myocardial SPECTs similarly, with an overall incidence of 11.5%(168/1462). Many apparent)y unrelated disease groups showed the finding: post-revascularization(53.9%), coronary artery disease(24.6%), myocardial infarction(12.3%), and those with normal coro-nary arteries (9.2%). Clinical and angiographic characteristics of 65 consecutive patients who underwent coronary arteriography in 168 patients who had RRD on myocardial perfusion SPECT were reviewed. Tc-99m MIBI was used in 44 patients, and T1-201 was used in 21 patients. Of the 81 myocardial segments analyzed which showed RRD, 32 segments(39.5%) were in septum, 24(29.5%) in inferior wallL, 12(14.8%) in anterior wall, 7(8.7%) in apex and 6(7.4%) in lateral wall. There was no clear association between RRD and coronary arterial stenosis or Presence of collateral circulations. Ventriculographical wall motion was evaluated in 27 regions with RRD; it was normal in 12 regions, hypokinetic in 12 regions and dyskinetic in 3 regions. In 14 of 21 patients who showed RRD on T1-201 myocardial SPECT, T1-201 reinjection was performed immediately after the 3-4 hour redistribution studies. Ten of 14 (71.4%) showed enhanced T1-201 activity(${\geq}10%$ increased) after reinjection. We conclude that RRD is not related to mode of stress or radiopharmaceuticals. RRD might represent many inhomogeneous pathophysiological processes.