Rest and Exercise Potassium-43 Myocardial Perfusion Imaging for the Noninvasive Evaluation of Aortocoronary Bypass Surgery

Abstract

Sixteen patients undergoing aortocoronary bypass surgery were evaluated with rest and exercise potassium-43 ( 43 K) myocardial imaging and contrast angiography an average of 5.5 months postoperatively. The results of 43 K imaging allowed the division of these patients into two groups. Group 1 consisted of patients in whom there was either normalization or significant improvement in postoperative images when compared to abnormal preoperative studies (five patients), or patients in whom preoperative imaging was not accomplished but whose postoperative images both at rest and exercise showed a normal homogenous pattern of 43 K distribution (four patients). All patients in this group had at least one patent bypass graft, and 13 of 16 total grafts were patent. Group 2 consisted of seven patients in whom postoperative rest and exercise 43 K studies were either not significantly different from preoperative evaluation, or had worsened. Of these patients, three experienced intraoperative infarction, two demonstrated significant distal native coronary disease, and one had a single occluded graft. In both groups there was good correlation between the anatomic sites of graft patency or occlusion and the location of either increased perfusion or lack thereof on the 43 K image. Perfusion abnormalities occurring in the presence of occluded grafts, or improvement in perfusion occurring in the presence of patent grafts were best appreciated by comparison of exercise images. Abnormalities occurring in the presence of infarction were detected at rest as well. Thus, in this initial group of patients, 43 K rest and exercise myocardial imaging appeared to offer a sensitive noninvasive means of evaluating the results of aortocoronary bypass surgery.