201Tl myocardial perfusion in the management of the transplanted heart

Abstract

A semi quantitative method with thallium has been applied in the management of cardiac transplants. In all, 142 scans were performed in 20 patients and were arranged in 3 groups that represent respectively all controls performed to the transplants (G1), and a selection of the scans obtained during the 1st rejection episode in each patient (G2) and the 2nd if present (G3). A heart/lung index was calculated through early and late images (IA, IB), obtained 5 min and 4 h post injection of thallium. A decrease in IA was detected during acute rejection in all groups. This fall was statistically significant from the mild to moderate rejection degree in G1 (P less than 0.01), and the mild rejection in G3 (P less than 0.001). IB was not modified with rejection. Comparing the biopsies with and without edema, in the absence of rejection, it has been proved that the intra myocardial edema can produce a decrease in IA (P less than 0.001). We conclude that IA is a simple and sensitive index to evaluate the graft, although intra myocardial edema can reduce its specificity.

Can non‐invasive methodology predict rejection and either dictate or obviate the need for an endomyocardial biopsy in pediatric heart transplant recipients?

“…The methods studied provide a history of the development of non‐invasive tools to assess cardiac function over the past 25 years. These methods range from intramyocardial leads placed at the time of transplantation (12) to the use of myocardial scintillography to detect changes in cardiac perfusion during rejection (13). As each new tool was incorporated into the care of the patient with heart disease, studies of its potential applicability in the diagnosis of cardiac allograft rejection inevitably followed.…”