[Left ventricular wall damage as an indicator for valve replacement in patients with volume overload: a radionuclide...

Using Tl-201 myocardial single photon emission computed tomography (SPECT), we tried to utilize the Tl-defects to determine the timing for aortic or mitral valve replacement in cases with chronic aortic (AR) or mitral regurgitation (MR), or both. Examinations including echocardiography and angiography were performed to evaluate left ventricular dilatation. Subjects consisted of 80 patients, including 22 with AR, 26 with MR, 17 with AR+MR, and 15 post-operative cases. The Tl-scores (sum of the grade of Tl-defects) correlated well with T wave abnormalities (V5) and NYHA functional class. The scores also correlated with left ventricular end-diastolic dimension (LVDd) and LV ejection fraction (LVEF), indicating that the LV wall defect progressed as the LV dimension increased with the increase in the volume load. Exercise Tl-201 myocardial SPECT revealed redistribution at an early stage of valvular regurgitation, indicating the development of LV wall damage in cases of LV enlargement due to regurgitation. Valve replacement caused a decrease in LVDd, with mild improvement in the Tl-score. We concluded that, in addition to the T wave changes and the echocardiographic measurements, Tl-201 myocardial SPECT should be included in the criteria for valve replacement.