Purpose
To investigate whether sympathetic nerve injury occurs during aortic surgery and how reinnervation takes place afterward.
Methods
Imaging with 123I-metaiodobenzylguanidine (MIBG) was performed in 12 patients (aortic group) who underwent aortic surgery (ascending replacement 3, ascending-arch replacement 9) before and 3 weeks after surgery. In 8 of 12 patients, MIBG scintigraphy was performed 1 and 2 years after surgery. Twelve patients (control group) who underwent open-heart surgery (mitral valve repair: 11; tricuspid valve replacement: 1) were studied using MIBG scintigraphy. The heart-to-mediastinum (H/M) activity ratio was obtained from planar images. The myocardial single-photon-emission computed tomography image was divided into five segments and the regional tracer uptake was scored from 0 = absent to 3 = normal uptake.
Results
No significant difference in the H/M ratio in either early and delayed planar scans was observed between both groups before surgery. The H/M ratios significantly decreased 3 weeks after surgery in the aortic group, whereas there was no significant change in the control group. The H/M ratio did not recover to the preoperative level within 2 years. In these 8 patients, the regional uptake of MIBG improved in the anterior and septal regions 1 year after surgery.
Conclusion
During ascending or ascending-arch replacement, the sympathetic nerve was globally denervated and slight reinnervation was observed within 2 years. The anterior and septal regions showed a rapid reinnervation, whereas other regions did not.
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Miyamoto, S., Hadama, T., Anai, H. et al. Denervation and Reinnervation of the Heart After Aortic Surgery, Estimated by 123I-Metaiodobenzylguanidine Scintigraphy. Surg Today 34, 226–230 (2004). https://doi.org/10.1007/s00595-003-2686-0
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DOI: https://doi.org/10.1007/s00595-003-2686-0