The transplantation of heart of reconstruction of left ventricle in female patient with ischemic heart disease complicated by cardiac insufficiency and electric storm: the role of tomoscintigraphy with phase images

Nowadays, the treatment of cardiac insufficiency of ischemic genesis still is an actual problem. The conclusions of competent controlled and randomized studies such as for example STICH are still ambiguous. In case of absence of success of modern therapeutic methods of treatment of cardiac insufficiency of ischemic genesis the cardiosurgery interference becomes an inevitable occurrence. Its last and radical stage is transplantation of heart. Another choice for patients with cardiac insufficiency of ischemic genesis formally liable to transplantation of heart can be extension of of traditional methods of cardiosurgery. The discussion of role of single-photon emission computed tomography in decision making concerning tactics of treatment is the purpose of study. To discuss such kind of decision a specific case is proposed to attention of reader. The female patient with cardiac insufficiency of ischemic genesis with implanted cardioverter defibrillator suffered from continuing everyday episodes of ventricular tachycardia - electric storm. The patient received anti-arrhythmia therapy, permanent intravenous infusion of lidocaine that correspond Status 1 according UNOS. Then patient was hospitalized as a recipient for transplantation of heart. However, the results of evaluation of myocardium applying technique of single-photon emission computed tomography synchronized with ECG and using phase images resulted in changing decision about carrying out of organ-preserving operation. The application of single-photon emission computed tomography made it possible to determine size and topography of transmural scar. This task could be achieved either by technique of single-photon emission computed tomography or by MRI. But implanted cardioverter defibrillator was a contra-indication to MRI. The single-photon emission computed tomography revealed volume of affection equal to 48%. The task to evaluate viable myocardium outside scar also could be achieved either by technique of single-photon emission computed tomography or by MRI. The task to determine topography of sources of pathological rhythm in ventricles could be implemented through visualization using phase images obtained under evaluation of results of gated SPECT. The preventive installation of intra-aortic balloon counterpulsation, resection of aneurysm of left ventricle and endoventriculoplastic by Dor was applied to patient. The follow-up months of monitoring detected no program triggering of implanted cardioverter defibrillator. The stable sinus rhythm was observed under standard extra systole and therapy with amiodarone. According data of single-photon emission computed tomography end-systolic volume of left ventricle decreased from 215 to 103 ml and ejection fraction of left ventricle increased from 23% to 34%. The six minute stepwise probe (6 minutes test) made up to 460 m. The application of single-photon emission computed tomography synchronized with ECG and using phase images makes it possible to make an adequate decision in choosing tactics of treatment of patients with implanted cardioverter defibrillator for whom conclusions of competent controlled and randomized studies still are ambiguous.

ischemic heart disease, transplantation, cardiac insufficiency, tomoscintigraphy