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Insights from the world's best medical minds

Role Of PET And SPET In Myocardial Viability

Dr. GN Mahapatra
Dr. GN Mahapatra, Senior Consultant & HOD Nuclear Medicine, Seven Hills Hospital, Mumbai
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Dr. GN Mahapatra

Senior Consultant & HOD Nuclear Medicine

Seven Hills Hospital, Mumbai


"Time is muscle, muscle is time. So the sooner the patient is treated the better" says Dr. GN Mahapatra.


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Complete Transcript

Dr. GN Mahapatra

The topic assigned to me is role of PET and SPECT in evaluation of myocardial viability before subjecting the patient to PCI ( percutaneous intervention). So what is happening in the present day clinical practice or a cardiac practice all over India is that, when a patient of acute MI visits a cardiologist, particularly interventional cardiologist, they usually do a primary angioplasty to the patient. Because time is muscle and muscle is time, so sooner is better, so if we revascularize the patient early then he would get 100%benefit , but if still there is a delay of couple of hours and primary angioplasty usually (01:00) down in those patients then the problem comes. What problems? The dead infarcted myocardium has been recanalized by dilated stent or balloon so that the blood supply will be restored, but if the muscle is dead, the blood supply will not be restored at all. So what is happening? They are doing a lot of primary angioplasties, but the patient goes home and comes back after a maximum of three to four weeks time complaining about shortness of breath or heaviness in the chest and then we do a PET scanning or a SPECT myocardial perfusion scanning to find out how was the angioplasty which was done when the patient had suffered a heart attack. But it is very alarming to know (02:00) and a matter of great concern that there are fixed defects at the stress and at rest and the myocardium is dead making angioplasty give zero benifit to the patient. In my nuclear cardiology practice, I usually see, two to three patients every week who come after the angioplasty and found to have dead myocardium and there are fixed defects. So, the patient is going to continue lifelong medical treatment and they will be depending totally on the medicines with their symptoms. So what is happening here is that if e the patient is of ST elevation MI, you can go ahead with a primary angioplasty. ST elevation plus (03:00) the symptoms limiting to 2 to 3 hours as compared to non-ST elevation MI with symptoms of heart attack more than 4 to 5 hours, do not attempt to do a primary angioplasty because it results in zero benifit to the patient.. Treat the patient conservatively and then, after the patient is settled , send for either a SPECT myocardial perfusion scan or a PET scanning to find out the extent and efface of the amount of myocardium which has been involved. If the myocardium which has been involved is still viable and healthy, please go ahead with the angioplasty or bypass surgery so that this type of particular patients do get benefit out of angioplasty or revascularization or CABG surgery. Similarly in (04:00) clinically stable angina, the patients whom I have been seeing for the last 36 years, are being taken to the cath lab and doing a coronary angiography followed by angioplasty without asserting the viability of myocardium. In clinically stable angina patient, it is mandatory requirement that the patient should go for a myocardial perfusion scan or a PET scan depending on the offordability of patient and see that there is viable myocardium, then those patients should be subjected for angioplasty or bypass surgery. Do not do a cosmetic angioplasty only for cosmetic purpose. It should be always for the benefit of the patient. That is my conclusion of today’s presentation.




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