Determination of culprit lesion in patients undergoing elective percutaneous coronary intervention by myocardial perfusion imaging.

UNLABELLED: The aim of this study was to determine and localize culprit lesion by myocardial perfusion imaging (MPI) in cases of angiographically detected coronary narrowing >or= 75% of at least one coronary artery. MATERIAL AND METHODS: One hundred and thirty-two (132) patients with angiographically detected significant coronary narrowing (>or= 75% luminal stenosis of at least one major coronary artery) were studied. All the patients submitted MPI (99m)Tc-MIBI, with pharmacologic dipyridamole stress protocol with concomitant low level bicycle exercise 50W (DipyEX). We measured relative uptake (99m)Tc-MIBI for each myocardial segment using short-axis myocardial tomogram study. A 5-point scoring system was used to assess the difference between uptake degree in stress and rest studies for the same segments, and we created two indices: Sum reversibility score (SRS), Index of sum reversibility score (ISRS). RESULTS: A total of 396 vascular territories (2244 segments) were analyzed before elective percutaneous coronary intervention (ePCI). Overall sensitivity, specificity and accuracy using SRS were 90.2%, 87.5%, and 89.4%, with a positive predictive value of 94.1%. Overall sensitivity, specificity, and accuracy using ISRS were 94.4%, 90.6%, 93.2% and the positive predictive value was 95.7%. CONCLUSION: DipyEX MPI with the two indices created, SRS and ISRS, significantly improves sensitivity, specificity and accuracy in the determination and localization of culprit lesions in patients undergoing elective PCI.

[Coronarography in the diagnosis of left atrial thrombosis]. / Koronarografija u dijagnostici tromboze leve pretkomore.

Thrombosis of left atrium is frequent in the patients with mitral defect. Systemic embolism that generates by separated thrombus parts is a possible complication during the disease. Echocardiography is routinely used in the diagnosis of left atrial thrombosis. On the basis of angiographic experience, we have set the hypothesis: coronary angiography has a great sensitivity, but small specificity in the diagnosis of left atrial thrombosis. The presence of thrombus in left atrium was analyzed in 60 operated patients with mitral valve disease. During the surgery, thrombus was found in 13, and not found in 47 patients. Coronary angiography was preoperatively performed in all patients. In 9 out of 13 patients with intraoperatively observed left atrial thrombus, thrombus was also found by angiography. In 47 patients thrombus was found neither intraoperatively, and in 45 nor by angiography. The sensitivity of angiography in the diagnosis of left atrial thrombosis is 69%, specificity is 97%, and the accuracy is 90%. Positive index of anticipation is 81%, and negative index of anticipation is 91%.

[Therapeutic embolization of the spleen]. / Terapijska embolizacija slezine.

Spleen embolization is a method of percutaneous occlusion of instrasplenic vascular network, by which is achieved a partial embolization of arterial branches with the convenience of controlled circulation reduction. Reduction achieved in this way corrects clinical and laboratory symptoms of hypersplenism and improves hematologic status in the diseases of lymphopoietic tissues where splenectomy is otherwise the therapeutic solution. This method had been applied experimentally, and afterward clinically since 1973, but with numerous complications and incidents. The authors had discussed those complications, commented the method development, so as physiopathologic and hemodynamic circumstances, and considering them, the method had become efficacious and safe. Using the modified methodologic principle, they had performed the first transcatheter spleen embolization at the Institute for Radiology of Military Medical Academy in the patient with liver cirrhosis, hypersplenism, splenomegaly and the signs of portal hypertension. The authors described the applied methods, postintervention effects and clinical and laboratory condition in six months after the intervention. Considering the positive clinical and laboratory results, the authors are of the opinion that the method of transcatheter spleen embolization is useful therapeutic alternative to splenectomy.