核素心肌断层显像诊断瓣膜病人合并冠状动脉病变的价值

The value of 99m Tc MIBI myocardial SPECT image for detecting coronary artery stenosis in patients with valvular disease

为了解瓣膜病患者是否合并冠状动脉病变，对６３例经临床确诊为瓣膜疾病的病人在外科手术前行９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）心肌断层显像，其中５５例做运动或药物负荷试验，８例单纯行静息心肌显像；２７例行冠状动脉造影；５７例行瓣膜外科手术。所有病人手术前、后均作超声心动图检查。结果：２７例心肌ＳＰＥＣＴ显像与冠状动脉造影结果对比，符合率为９６３％（２６／２７）；与冠状动脉造影、外科手术后临床及超声检查结果对比，阴性预测值为１００％。由此可见，核素心肌ＳＰＥＣＴ显像诊断瓣膜病人合并冠状动脉病变，尤其是作为瓣膜手术前冠状动脉造影的筛选，是一种准确性高、有价值的无创性方法。

PURPOSE To detect the coronary artery disease in patients with valvular disease METHODS 63 patients with valvular disease were studied using 99m Tc MIBI myocardial SPECT image before surgical operation Coronary artery angiography was performed in 27 patients before operation and 57 patients underwent surgical therapy Echocardiography was also performed in all patients before and after surgical operation RESULTS In 26 cases, the results of myocardial SPECT image were in concordence with those of coronary artery angiography, the accuracy rate was 96 3% In 57 patients who underwent surgical operation, coronary artery angiography was performed in 26 patients, 3 cases with significant pathological changes of coronary artery, valve replacement and CABG were performed, others only underwent valve replacement All cases had normal echocardiography after operation CONCLUSIONS [WT5”BZ] 99m Tc MIBI myocardial SPECT images is a reliable method for detecting the coronary artery disease in patients with valvular disease It can be used to select suitable patients for coronary artery angiography