Myocardial perfusion scintigraphy with thallium-201 in elderly patients after internal mammary artery revascularisation

Krzysztof Chizynski¹, Jacek Kusmierek², Ryszard Jaszewski¹, Janusz Zaslonka¹

Summary
Introduction: The aim of the study was to investigate the problem of sufficient or insufficient myocardial perfusion during exercise in elderly patients after internal mammary artery (IMA) bypass, and to define the possible relationship between IMA flow and postoperative myocardial perfusion.
Material and methods: The study group was 81 patients aged 70-86 yrs. (mean 76 yrs.) who underwent IMA bypass surgery. IMA flow was measured during surgery in all patients (performed off bypass with no resistance), and thallium 201 perfusion scintigraphy was performed 3 months after bypass procedure.
Results: The IMA flow in our study was 40 to 200 ml/min (mean: 117). Good surgical results, defined as normal perfusion in both exercise and rest scintigrams, or very small perfusion defects in exercise scintigrams and normal perfusion in rest ones, were observed in 66 patients (81.5%). Thallium-201 perfusion scintigrams were analyzed separately in patients with IMA flow below 100 ml/min and over 100 ml/min. Good bypass results were observed in 53 patients (94.6%%) with IMA flow over 100 ml/min, but only in 13 patients (52%) with IMA flow below 100 ml/min (p <0.001). Poor surgical results were found in 12 patients (48%) with IMA flow below 100 ml/min, and only in 3 patients (5.4%) with IMA flow over 100 ml/min (p <0.001).
Conclusion: IMA flow measured intraoperatively has an important influence on coronary operation results in elderly patients. If we use IMA only in cases where the minimal flow is at least 100 ml/min, we could improve the outcome of coronary operations.

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