Kostuk W J, Chamberlain M J
Can J Surg. 1977 Mar;20(2):112-7.
Evaluation of patients for aotocoronary bypass (ACB) surgery is dependent on the findings at cardiac catheterization. Left ventricular angiography cannot distinguish between reversible and irreversible myocardial dysfunction. In 82 patients macroaggregates of human serum albumin, labelled with iodine-131, were injected before operation into the right coronary artery and technetium-99m labelled microspheres were injected into the left coronary artery. Two weeks after operation similar technetium-99m and iodine-131 injections were made into the native vessels and grafted vessels, respectively. Myocardial distribution of the 20 mu particles was visualized with a rectillinear scanner. Sixty-seven patients had normal myocardial perfusion scans preoperatively even though wall motion was abnormal in 34. There was substantial improvement in the left ventricular function of these 34 patients; the mean ejection fraction increased from 56 to 65%. Fifteen patients had abnormal myocardial perfusion scans; improvement in left ventricular function in this group occurred only if the bypass graft was made to an area with normal regional perfusion preoperatively. It is certain that an adequate capillary bed is present if the myocardial scan is normal, regardless of the degree of critical stenosis in either coronary artery. The patient with a completely occluded coronary artery and normal myocardial scan is a good candidate for ACB and will show improved left ventricular contraction if the ACB is patent,
对患者进行冠状动脉搭桥术（ACB）手术的评估取决于心导管检查的结果。左心室血管造影无法区分可逆性和不可逆性心肌功能障碍。在82例患者中，术前将碘-131标记的人血清白蛋白大颗粒注入右冠状动脉，将锝-99m标记的微球注入左冠状动脉。术后两周，分别将类似的锝-99m和碘-131注入原有血管和移植血管。用直线扫描仪观察20微米颗粒的心肌分布。67例患者术前心肌灌注扫描正常，尽管其中34例患者的室壁运动异常。这34例患者的左心室功能有显著改善；平均射血分数从56%提高到65%。15例患者心肌灌注扫描异常；仅当搭桥移植到术前区域灌注正常的区域时，该组患者的左心室功能才会改善。如果心肌扫描正常，无论冠状动脉临界狭窄程度如何，肯定存在足够的毛细血管床。冠状动脉完全闭塞但心肌扫描正常的患者是ACB手术的良好候选者，如果ACB通畅，其左心室收缩功能将得到改善。
