Nuclear cardiology and coronary surgery.

ABSTRACT

Rising age, repeated percutaneous coronary revascularizations, and co-morbidity such as overweight, diabetes, and hypertension, characterize a change over the last 20-30 years in coronary patients referred to coronary artery bypass grafting (CABG). This patient group represents a great part of today's large and increasing patient population with heart failure, and their treatment remains a limited success. CABG may lead to symptomatic and prognostic improvement, but the limited risk of operative complications has to be balanced against the chances of symptomatic and prognostic benefit from the operation. Identification of culprit lesions and estimation of the severity of coronary stenoses of intermediate or uncertain degree are important in preoperative decision-making. Location and extent of a perfusion abnormality must reflect the anatomical distribution of an angiographic stenosis, supporting or arguing against the decision to revascularize . Myocardial perfusion imaging by single photon emission computed tomography or positron emission tomography before surgery will increase the level of information about coronary hemodynamics and myocardial viability before surgical intervention and is therefore highly recommended to increase the chances of successful coronary surgery, as well as to reduce the small risk of operative complications.