Rest and exercise potassium 43 myocardial perfusion imaging for the noninvasive evaluation of aortocoronary bypass surgery

Sixteen patients undergoing aortocoronary bypass surgery were evaluated with rest and exercise potassium 43 (⁴³K) myocardial imaging and contrast angiography an average of 5.5 mth postoperatively. The results of ⁴³K imaging allowed the division of these patients into 2 groups. Group 1 consisted of patients in whom there was either normalization or significant improvement in postoperative images when compared to abnormal preoperative studies (5 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 ⁴³K distribution (4 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 7 patients in whom postoperative rest and exercise ⁴³K studies were either not significantly different from preoperative evaluation, or had worsened. Of these patients, 3 experienced intraoperative infarction, 2 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 ⁴³K 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, ⁴³K rest and exercise myocardial imaging appeared to offer a sensitive noninvasive means of evaluating the results of aortocoronary bypass surgery.