open access

Vol 22, No 2 (2019)
Original articles
Published online: 2019-07-31
Submitted: 2019-04-26
Accepted: 2019-06-24
Get Citation

Lung perfusion scintigraphy in the assessment of pulmonary circulation after completion of surgical treatment of a hypoplastic left heart syndrome (HLHS)

Katarzyna Kovaćević-Kuśmierek, Anna Mazurek-Kula, Tomasz Moszura, Jadwiga Moll, Anna Płachcińska, Jacek Kuśmierek
DOI: 10.5603/NMR.2019.0018
·
Pubmed: 31482561
·
Nucl. Med. Rev 2019;22(2):81-84.

open access

Vol 22, No 2 (2019)
Original articles
Published online: 2019-07-31
Submitted: 2019-04-26
Accepted: 2019-06-24

Abstract

INTRODUCTION: Hypoplastic left heart syndrome (HLHS) is an inborn complex heart malformation. A multi-stage treatment is initiated in a neonatal period with a Norwood surgery. The next step is Glenn surgery — a bidirectional superior cavo-pulmonary anastomosis. At the last stage anastomosis of inferior vena cava (IVC) with the right pulmonary artery (RPA) is formed as a result of a Fontan surgery. The aim of this study was to assess lung perfusion in patients with HLHS after completion of a surgical therapy, using a scintigraphic method.

MATERIAL AND METHODS: In 92 patients with HLHS a planar lung scintigraphy in anterior and posterior projections after administration of 99mTc-macroaggregates in activity 18-111MBq was carried out twice (in several day intervals). At first, a radiopharmaceutical was administered to the right extremity in order to assess the lung distribution of blood flowing through the anastomosis of superior vena cava (SVC) with RPA. In the next study, after administration of the tracer to the right lower extremity, the distribution of blood flowing through the anastomosis of IVC with RPA was assessed. The relative percentage of each lung in the total lung perfusion was calculated on a Xeleris workstation using the “Lung perfusion analysis” program. Lung perfusion was considered close to symmetrical when the proportion was in the range of 40–60%.

RESULTS: In spite of the fact that mean relative values of distribution of blood flowing through the anastomosis of SVC with RPA to the left lung (LL) and right lung (RL) in the entire study group did not differ significantly: LLmean = 47%; RLmean = 53%, p = 0.14, relative values of perfusion of both lungs were differentiated — in 26% of patients LL was better perfused, in 38% RL was better perfused and in 36% a perfusion of both lungs was similar. The analysis of blood distribution by anastomosis of IVC with RPA showed that the mean relative perfusion of RL was significantly higher than that of LL (70% vs. 30%, p < 0.0000001). No signs of pulmonary emboli were detected. In 13% of studied patients, uptake of the radiopharmaceutical in kidneys was shown indicating the presence of shunt “from right to left”.

CONCLUSIONS: After completion of surgical treatment of patients with HLHS, differentiated blood supply of the lungs was observed through SVC with RPA anastomosis and a tendency to higher blood supply of RL than LL by anastomosis of IVC with RPA. No signs of pulmonary embolism were detected. The study revealed a “right to left” shunt in some patients.

Abstract

INTRODUCTION: Hypoplastic left heart syndrome (HLHS) is an inborn complex heart malformation. A multi-stage treatment is initiated in a neonatal period with a Norwood surgery. The next step is Glenn surgery — a bidirectional superior cavo-pulmonary anastomosis. At the last stage anastomosis of inferior vena cava (IVC) with the right pulmonary artery (RPA) is formed as a result of a Fontan surgery. The aim of this study was to assess lung perfusion in patients with HLHS after completion of a surgical therapy, using a scintigraphic method.

MATERIAL AND METHODS: In 92 patients with HLHS a planar lung scintigraphy in anterior and posterior projections after administration of 99mTc-macroaggregates in activity 18-111MBq was carried out twice (in several day intervals). At first, a radiopharmaceutical was administered to the right extremity in order to assess the lung distribution of blood flowing through the anastomosis of superior vena cava (SVC) with RPA. In the next study, after administration of the tracer to the right lower extremity, the distribution of blood flowing through the anastomosis of IVC with RPA was assessed. The relative percentage of each lung in the total lung perfusion was calculated on a Xeleris workstation using the “Lung perfusion analysis” program. Lung perfusion was considered close to symmetrical when the proportion was in the range of 40–60%.

RESULTS: In spite of the fact that mean relative values of distribution of blood flowing through the anastomosis of SVC with RPA to the left lung (LL) and right lung (RL) in the entire study group did not differ significantly: LLmean = 47%; RLmean = 53%, p = 0.14, relative values of perfusion of both lungs were differentiated — in 26% of patients LL was better perfused, in 38% RL was better perfused and in 36% a perfusion of both lungs was similar. The analysis of blood distribution by anastomosis of IVC with RPA showed that the mean relative perfusion of RL was significantly higher than that of LL (70% vs. 30%, p < 0.0000001). No signs of pulmonary emboli were detected. In 13% of studied patients, uptake of the radiopharmaceutical in kidneys was shown indicating the presence of shunt “from right to left”.

CONCLUSIONS: After completion of surgical treatment of patients with HLHS, differentiated blood supply of the lungs was observed through SVC with RPA anastomosis and a tendency to higher blood supply of RL than LL by anastomosis of IVC with RPA. No signs of pulmonary embolism were detected. The study revealed a “right to left” shunt in some patients.

Get Citation

Keywords

HLHS; Fontan surgery; lung perfusion scintigraphy

About this article
Title

Lung perfusion scintigraphy in the assessment of pulmonary circulation after completion of surgical treatment of a hypoplastic left heart syndrome (HLHS)

Journal

Nuclear Medicine Review

Issue

Vol 22, No 2 (2019)

Pages

81-84

Published online

2019-07-31

DOI

10.5603/NMR.2019.0018

Pubmed

31482561

Bibliographic record

Nucl. Med. Rev 2019;22(2):81-84.

Keywords

HLHS
Fontan surgery
lung perfusion scintigraphy

Authors

Katarzyna Kovaćević-Kuśmierek
Anna Mazurek-Kula
Tomasz Moszura
Jadwiga Moll
Anna Płachcińska
Jacek Kuśmierek

References (20)
  1. Gobergs R, Salputra E, Lubaua I. Hypoplastic left heart syndrome: a review. Acta Med Litu. 2016; 23(2): 86–98.
  2. Greenleaf CE, Urencio JM, Salazar JD, et al. Hypoplastic left heart syndrome: current perspectives. Transl Pediatr. 2016; 5(3): 142–146.
  3. Fruitman DS. Hypoplastic left heart syndrome: Prognosis and management options. Paediatr Child Health. 2000; 5(4): 219–225.
  4. Tamir A, Melloul M, Berant M, et al. Lung perfusion scans in patients with congenital heart defects. J Am Coll Cardiol. 1992; 19(2): 383–388.
  5. Fathala A. Quantitative lung perfusion scintigraphy in patients with congenital heart disease. Heart Views. 2010; 11(3): 109–114.
  6. Itani M, Matesan M, Ahuja J, et al. The Role of Pulmonary Scintigraphy in the Evaluation of Adults with Congenital Heart Disease. Semin Nucl Med. 2017; 47(6): 660–670.
  7. Wu MT, Huang YL, Hsieh KS, et al. Influence of pulmonary regurgitation inequality on differential perfusion of the lungs in tetralogy of Fallot after repair: a phase-contrast magnetic resonance imaging and perfusion scintigraphy study. J Am Coll Cardiol. 2007; 49(18): 1880–1886.
  8. Boothroyd AE, McDonald EA, Carty H. Lung perfusion scintigraphy in patients with congenital heart disease: sensitivity and important pitfalls. Nucl Med Commun. 1996; 17(1): 33–39.
  9. Yin Z, Wang H, Wang Z, et al. Radionuclide and angiographic assessment of pulmonary perfusion after Fontan procedure: comparative interim outcomes. Ann Thorac Surg. 2012; 93(2): 620–625.
  10. Glass T, Heyman S, Seliem M, et al. Use of Tc-99m MAA in Determining the Etiology of Increasing Cyanosis Following SVC-PA Anastomosis for the Hypoplastic Left Heart Syndrom. Clinical Nuclear Medicine. 1991; 16(6): 410–412.
  11. Torso S, Milanesi O, Bui F, et al. Radionuclide evaluation of lung perfusion after the Fontan procedure. International Journal of Cardiology. 1988; 20(1): 107–116.
  12. Varma C, Warr MR, Hendler AL, et al. Prevalence of "silent" pulmonary emboli in adults after the Fontan operation. J Am Coll Cardiol. 2003; 41(12): 2252–2258.
  13. Fratz S, Hess J, Schwaiger M, et al. More accurate quantification of pulmonary blood flow by magnetic resonance imaging than by lung perfusion scintigraphy in patients with fontan circulation. Circulation. 2002; 106(12): 1510–1513.
  14. Casella SL, Kaza A, Del Nido P, et al. Targeted Increase in Pulmonary Blood Flow in a Bidirectional Glenn Circulation. Semin Thorac Cardiovasc Surg. 2018; 30(2): 182–188.
  15. Matsushita T, Matsuda H, Ogawa M, et al. Assessment of the intrapulmonary ventilation-perfusion distribution after the Fontan procedure for complex cardiac anomalies: relation to pulmonary hemodynamics. J Am Coll Cardiol. 1990; 15(4): 842–848.
  16. Viswanathan S. Thromboembolism and anticoagulation after Fontan surgery. Ann Pediatr Cardiol. 2016; 9(3): 236–240.
  17. Bartolome BF, Martinez PF, Zurita BM. Pulmonary thromboembolism after Fontan operation. Rev Esp Cardiol. 2002; 55: 449–451.
  18. Cloutier A, Ash JM, Smallhorn JF, et al. Abnormal distribution of pulmonary blood flow after the Glenn shunt or Fontan procedure: risk of development of arteriovenous fistulae. Circulation. 1985; 72(3): 471–479.
  19. Pruckmayer M, Zacherl S, Salzer-Muhar U, et al. Scintigraphic assessment of pulmonary and whole-body blood flow patterns after surgical intervention in congenital heart disease. J Nucl Med. 1999; 40(9): 1477–1483.
  20. Rosenbaum RC, Reiner BI, Bidwell JK, et al. Right-to-left shunting via persistent left superior vena cava identified by perfusion lung scintigraphy. J Nucl Med. 1989; 30(3): 412–414.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., Świętokrzyska 73 street, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl