Preoperative Risk Assessment. Prepared by Dr Gabriel Castro.

 

  

  

                                                                                                        

 

 

Cuadro de texto: RC Cuadro de texto: Cx Cuadro de texto: AD

 

 

           

            79y/o male, DM, AHT, asymptomatic who was hospitalized for surgical treatment of righ foot  Wagner ulcer and acute ischemic disease. As part of preoperative tests, he underwent dipyridamole Tc99m SESTAMIBI myocardial perfusion spect. The SPECT was compatible with severe coronary disease, this fact was lately confirmed by coronary angiography. Due to high risk of  perioperative cardiovascular event, conservative treatment was decided.
            On the planar anterior view for stress and rest  image it can be seen increased lung sestamibi uptake at stress, due to left ventricular dysfunction (arrow), which disappears at rest. Tc99m SESTAMIBI myocardial perfusion spect with intense apical and inferolateral  moderate size perfusion defects  reversible at rest images but just partial (yellow arrows), associated with wall  hypokinetic  motion. LVEF at rest: 50% and decreases to 35% at stress. All these findings are secondary to severe coronary desease, (1) that later was confirmed with coronary angiography.Coronary angiography: Right Coronary (RCA): Stenosis 60-70% medial segment, 80% distal segment. Anterior Descending (LAD) : Origin and proximal segment: 70-80% stenosis. Circumflex: High lateral with 90% stenosis, second marginal 80%, posterolateral branch 90% .
             The myocardial perfusion spect is widely used for cardiac risk assesment in non cardiac surgery (2). Patients with a normal study have low risk of perioperative cardiac events, but those with moderate to severe perfusion defects have high cardiovascular events risk and poor long term prognosis (3).
 

References:

1) Hansen CL, Goldstein RA, Akinboboye OO, Berman DS, Botvinick EH, Churchwell KB, Cooke CD, et al. ASNC Imaging Guidelines For Nuclear Cardiology Procedures. Myocardial perfusion and function: Single photon emission computed tomography. J Nucl Cardiol 2007;14:e39-60.

2) Fleisher L, Beckman J, Brown K, Calkins H, Chaikof E, Fleischman  K et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for non cardiac surgery.J Am Coll Cardiol 2007; 17:161-228.

3) Cohen M, Siewers A, Dickens J, Hill T, Muller J. Perioperative and long-term prognostic value of dipyridamol Tc99m sestamibi myocardial tomography in patients evaluated for elective vascular surgery.. J Nucl Cardiol 2003; 10: 464-72.

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