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Detection of Perioperative Coronary Vasospasm on Iodine-123-MIBG, Thallium-201 and Iodine-123-BMIPP Myocardial SPECT Images

Department of Internal Medicine, Kinki Central Hospital, Itami, Japan

Correspondence: For correspondence or reprints contact: Koji Kodama, MD, The Second Department of Internal Medicine, Ehime University School of Medicine, Shitsukawa, Shigenobu-cho, Onsen-gun, Ehime 791-02, Japan.

ABSTRACT

A 64-yr-old woman, who had no history of anginal attack, underwent cholecystectomy under general anesthesia. A few hours after successful surgery, the EKG showed T-wave inversions with QT-interval prolongations and torsades de pointes. The [¹²³I]MIBG scintigraphic findings revealed marked denervation in the anteroseptal and inferoposterior myocardium, whereas ²⁰¹Tl myocardial SPECT showed only slightly reduced tracer uptake in those areas. The [¹²³I]BMIPP scans showed abnormal fatty acid metabolism in the anteroseptal myocardium. Coronary angiogram detected no fixed stenosis, but coronary vasoconstriction in the left anterior descending artery was induced by intracoronary injection of acetylcholine. In our patient, the findings of cardiac imaging with [¹²³I]MIBG, ²⁰¹Tl and ¹²³I]BMIPP led to coronary angiography and the final diagnosis of probable penoperative coronary vasospasm.

Key Words: perioperative coronary vasospasm • iodine-123-MIBG • thallium-201 • iodine-123-BMIPP • single-photon emission computed tomography

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