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Ann Thorac Surg 1979;27:42-48
© 1979 The Society of Thoracic Surgeons
Departments of Surgery, Cardiothoracic Surgery Division, Radiology (Nuclear Medicine), Pathology, and Internal Medicine (Cardiology) at The New York Hospital-Cornell Medical Center, New York, NY.
Accepted for publication April 10, 1978.
* Address reprint requests to Dr. Roberts, Division of Cardiothoracic Surgery, Northwestern University Medical School, 303 E Chicago Ave, Ward Building, 9-105, Chicago, IL 60611.
The present study was performed to evaluate scintigraphic imaging with technetium 99m-labeled glucoheptonate and serum enzyme levels of creatine phosphokinase isoenzyme (MB-CPK) in the early diagnosis of perioperative acute myocardial infarction associated with saphenous vein bypass graft operations. Myocardial imaging was done in 27 patients (50% of whom were considered high-risk) before operation and again 5 hours after operation. Four of these patients (15%) had both electrocardiographic and serum MB-CPK evidence of acute myocardial infarction, and all 4 had developed positive postoperative scintigrams. Four other patients had only elevated serum MB-CPK, and scintigrams became positive after operation in 3 of them. In addition, serum MB-CPK 6 hours after operation was 83 ± 21 mIU/ml (mean ± standard error of the mean) in patients with positive post-operative scans compared with 24 ± 5 mIU/ml in those patients with negative postoperative scintigrams (p < 0.001).
Myocardial imaging with 99mTc-glucoheptonate in the perioperative period is rapid, safe, and atraumatic. Furthermore, our results suggest that it is a sensitive method for the early diagnosis of perioperative acute myocardial infarction, and, when imaging is combined with serum MB-CPK isoenzyme analysis, the reliability of the diagnosis of acute myocardial infarction is enhanced even further. Only 1 of the patients who showed perioperative myocardial damage had acute hemodynamic compromise or obvious impairment of recovery in the immediate postoperative period, and the 30-day mortality of the total group was 4% (1 of 27).
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A. J. Roberts Perioperative Myocardial Infarction and Changes in Left Ventricular Performance Related to Coronary Artery Bypass Graft Surgery Ann. Thorac. Surg., February 1, 1983; 35(2): 208 - 225. [Abstract] [PDF]
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A. J. Roberts, J. H. Sanders Jr., J. M. Moran, K. J. Kaplan, P. R. Lichtenthal, S. M. Spies, and L. L. Michaelis Nonrandomized Matched Pair Analysis of Intermittent Ischemic Arrest versus Potassium Crystalloid Cardioplegia during Myocardial Revascularization Ann. Thorac. Surg., June 1, 1981; 31(6): 502 - 511. [Abstract] [PDF]
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L. D. Voegele, A. J. Gross, W. H. Prioleau Jr., and P. Hairston Application of Multivariate Analysis to the Enzyme Patterns in the Serum of Patients Undergoing Coronary Artery Operation Ann. Thorac. Surg., May 1, 1980; 29(5): 444 - 450. [Abstract] [PDF]
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