Persantine Stress Study - pre Neurosurgery

[Cindy]

2 yrs ago, a plate was put into my brain after sinus surgery, because the surgeon punctured through to my brain. About 4 mos. ago I began having swelling around the plate and was scheduled for a 2nd Neurosurgery because the Neuro. suspects an infection behind plate in the frontal area of my brain.

I had pre-surgery testing and the EKG was "abnormal".  On 3/28/06 they sent me for a Persantine Stress Study and the results are:

DX:  HTN, SOB, Abnormal EKG
Patient:  55 year old female w/ history of mitral valve regurgitation.

After Persantine Infusion, 32.2 mCi of TC SESTAMIBI were injected. At rest 11.0 MCi of TC SESTAMIBI were injected.  Short axis, vertical long axis and horizontal long axis tomographic reconstructions were calculated from ther est & post infusion images.

CONCLUSION:
1) On the immediate post infusion tomograms there is moderate anteroapical malperfusion defect.
2) On the rest tomograms there is no significant change of the antercapical defect.
3) Resting gated images indicate normal wall thickening and wall function except for the diminished uptake reduced apical function.
4) Ejection Fraction = 56%

AORTA: Root:  3.0 Valve Opening:  2.1;  Left Atrium:  4.0
DOPPLER STUDY: Mitral Valve Regurgitation:  "Trace"

CONCLUSION:
1) Normal LV size & overall normal LV systolic function
2) Trace mitral regurgitation
3) Technically difficult study.

Is it OK for me to go ahead with brain surgery?  They have me scheduled for Wednesday, April 5, 2006.  My concern is that the conclusion says "technically difficult study" - HELP!

[Cindy]

This website is a Godsend - thank you a million times for taking the time to reply to my questions!!

Cindy

[CCF-M.D.-MJM]

Hi Cindy,

Sorry to hear about your upcoming surgery.

You are in a tricky situation.  The algorhythm for pre op clearance can be found at the following website.

http://webmedia.unmc.edu/intmed/geriatrics/reynolds/pearlcards/preop/preopdescription.htm

This is a summary of the ACC guidelines.  You had a cardiology evaluation because of shortness of breath from your report says.  They did not come to a firm conclusion as to whether your study was positive or showing ischemia.  This is tricky.  If you really needed the stress test because of those symptoms, then you should have further work up done until the question is answered.  Sometimes doctors will order stress tests to make sure things are ok and get stuck with inconclusive data like yours and are forced to say I think they need a cath or not.  The decision of whether or not to proceed can only be made the person talking to you.  It is often very difficult.  If there is any doubt, get a second opintion.  

Surgeons don't like heart problems. I doubt they would proceed if they are concerned, but make sure you are comfortable with the decision.  If the surgery is an emergency, this is all a moot point and you should have the surgery.

Good luck with the surgery and thanks for posting.