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Ann Thorac Surg 1976;21:311-317
© 1976 The Society of Thoracic Surgeons

Articles

Technetium Stannous Pyrophosphate Myocardial Scintigrams in the Recognition of Myocardial Infarction in Patients Undergoing Coronary Artery Revascularization

Melvin R. Platt, M.D.*, Frederick J. Bonte, M.D., William Shapiro, M.D., Winfred L. Sugg, M.D.

From the Departments of Surgery (Thoracic Surgery Division), Radiology (Nuclear Medicine), and Internal Medicine (Cardiac Unit), the University of Texas Southwestern Medical School, Parkland Memorial Hospital, and the Veterans Administration Hospital, Dallas, TX.

Robert W. Parkey, M.D.*, James T. Willerson, M.D.{dagger}

* Scholar in Radiological Research, the James Picker Foundation
{dagger} Established Investigator, American Heart Association

Accepted for publication September 29, 1975.

* Address reprint requests to Dr. Platt, Department of Surgery, The University of Texas Health Science Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75235

Myocardial imaging using technetium 99m stannous pyrophosphate (99mTc-PYP) has been utilized preoperatively and three to five days postoperatively to detect myocardial infarction in 48 patients undergoing aortocoronary bypass grafting, including 7 having valve replacement (5 aortic, 2 mitral) in addition to revascularization. In the total group of patients operated on there were 3 deaths (6%). Preoperatively, 26 patients had unstable angina and 10 had severe left main coronary artery disease. Eleven of the 48 (23%) were women. ECG and enzyme-proved infarctions occurred in 6 of the 48 patients (12%), but the addition of 99mTc-PYP myocardial imaging demonstrated scintigraphic evidence of infarction in 15 patients (31%), including 2 who died in the operating room.

The 99mTc-PYP myocardial imaging technique, which has proved safe, simple, and relatively inexpensive in these patients, suggests that the incidence of infarction after coronary bypass operations is somewhat higher than has been previously recognized from just ECG and enzyme changes. This technique also has been of value in helping to exclude myocardial infarction in difficult clinical situations such as postoperative arrhythmias and the post-pericardiotomy syndrome.




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