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J Thorac Cardiovasc Surg 2009;138:241-243
© 2009 The American Association for Thoracic Surgery

Brief Technique Report

Radio-guided surgery for ventricular remodeling in patients with ischemic dilated cardiomyopathy: A new tool to discriminate in vivo viable myocardium and scar

Marco Spadafora, MDa,d,*, Fiore Manganelli, MDb, Luigi Mansi, MDc,d, Paolo Ferrara, MDb, Paolo Miletto, MDa, Giuseppe Rosato, MDb, Pierluigi Costanzo, MDe, Alberto Cuocolo, MDe,f

a Department of Imaging, S.G. Moscati Hospital, Avellino, Italy
b Department of Cardiology and Heart Surgery, S.G. Moscati Hospital, Avellino, Italy
c Department of Imaging, Second University of Naples, Naples, Italy
d Centre of Excellence in Cardiology, Second University of Naples, Naples, Italy
e SDN Foundation, Institute of Diagnostic and Nuclear Development, University Federico II, Naples, Italy
f Department of Biomorphological and Functional Sciences, University Federico II, Naples, Italy

Received for publication May 13, 2008; revisions received May 29, 2008; accepted for publication June 7, 2008.

* Address for reprints: Marco Spadafora, MD, Department of Imaging, S.G. Moscati Hospital, Via Otranto, 83100 Avellino, Italy. (Email: spamar@libero.it).

The first 20% of the full text of this article appears below.


   Introduction
 
Acombined surgical procedure, left ventricular restoration (LVR), which consists of coronary artery bypass grafting and endoventricular patch plasty (EPP), is under investigation in the on-going Surgical Treatment for Ischemic Heart Failure trial.1Go EPP can provide restoration of left ventricular (LV) size and geometry by excluding nonviable areas. At present, the differentiation of viable tissue and scar tissue is based on using subjective methods to assess morphologic features, such as consistency, thickness, and color of the wall, and it might be inadequate on the surgical table. We assessed the feasibility of in vivo radio-guided surgery (RGS) with a gamma probe as an objective tool to differentiate viable tissue and scar tissue in patients undergoing EPP.


   Clinical Summary
 
Two patients with previous anterior myocardial infarctions were selected for LVR (Table 1 ). Informed consent and the approval of the local ethics committee were obtained. One week before LVR, patients underwent gated single-photon emission computed tomography (SPECT) with Tc-99m sestamibi to assess myocardial perfusion and LV function.2Go Twelve hours before LVR, the same imaging protocol was repeated for the in vivo analysis of . . . [Full Text of this Article]






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