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The Assessment of Pulmonary Parenchymal Damage in Congenital Heart Disease using Lung Perfusion Scan

Journal of the Korean Pediatric Society 1998;41(5):640-645.
Published online May 15, 1998.
The Assessment of Pulmonary Parenchymal Damage in Congenital Heart Disease using Lung Perfusion Scan
Hong Ryang Gil1, Jae Goo Lee1, Kang Uk Lee2, Eun Ho Yi3, Myung Ja Yun4, Chung Il Noh4, Jung Yeon Choi4, Yong Soo Yun4
1Department of Pediatrics, College of Medicine, Chungnam National University, Korea
2Department of Internal Medicine, College of Medicine, Chungnam National University, Korea
3Department of Nuclear Medicine, College of Medicine, Chungnam National University, Korea
4Department of Pediatrics, College of Medicine, Sung Kyun Kwan University, Seoul, Korea
선천성 심질환에서 폐관류주사를 이용한 폐실질손상의 평가
길홍량1, 이재구1, 이강욱2, 이은호3, 윤명자4, 노정일4, 최정연4, 윤용수4
1충남대학교 의과대학 소아과학교실
2충남대학교 의과대학 소아과학교실
3충남대학교 의과대학 핵의학과
4성균관대학교 의과대학 강북삼성병원 소아과
Correspondence: 
Hong Ryang Gil, Email: 1
Abstract
Purpose
: In acyanotic congenital heart disease of children with left to right shunt, 99mTc- Macroaggregate albumin(MAA) was employed to determine the scintigraphic severity of pulmonary parenchymal damage.
Methods
: These data of lung perfusion scan using 99mTc-MAA were compared with hemodynamic values obtained from cardiac catheterization.
Results
: The mean Pulmonary arterial pressure(≥30mmHg), total pulmonary resistance(≥2 Wood unit) & ratio of pulmonary vascular resistance/systemic resistance(Rp/Rs ≥0.2) were proportionally related to higher perfusion ratio of upper and lower lung field. The diagnostic values of perfusion ratio of upper & lower field of both lung(cut off value ≥0.8) for pulmonary hypertension were as follows : 60-65% of sensitivity, 75-90% of specificity, 72-86% of positive predictive value & 68-69% of negative predictive value. The mottled perfusion defect was frequently found in patients with pulmonary hypertension(mean pulmonary arterial pressure ≥30mmHg, Rp ≥2Wood unit). The degree of perfusion defect as indicator of severe pulmonary parenchymal damage was utilized clinically as determinator of operability and morbidity for acyanotic shunt lesions perioperatively.
Conclusion
: The scintigraphic severity determined by 99mTc-MAA lung perfusion scan could be valid for evaluating the extent of pulmonary parenchymal damage in acyanotic congenital heart disease complicated by pulmonary hypertension.
Key Words: Lung perfusion scan, Acyanotic congenital heart disease, Pulmonary parenchymal damage


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