Scintigraphic evaluation of left ventricular aneurysm

Gated cardiac blood pool scintigraphy is a noninvasive method to assess regional and global left ventricular function in the patient with suspected true or false left ventricular aneurysm after a myocardial infarction. The procedure is easy to perform and provides reproducible, high resolution images that can accurately distinguish regional from diffuse contractile abnormalities often present after myocardial infarction. An overall accuracy rate of 96 percent for detection of left ventricular aneurysm can be obtained with gated cardiac blood pool scintigraphy as compared with contrast left ventriculography. The procedure also permits assessment of functional reserve of the noninvolved myocardium and thus can provide valuable information on whether enough viable myocardium will remain after aneurysmectomy. The addition of thallium-201 myocardial perfusion scintigraphy may aid in the separation of viable from scarred myocardium at the edge of the aneurysm. Both radionuclide techniques are well suited for screening the patient after infarction with persistent congestive heart failure, malignant arrhythmia or systemic emboli in whom a left ventricular aneurysm may have developed.