Bronchial artery perfusion scintigraphy to assess bronchial artery blood flow after lung transplantation

The bronchial arterial system is inevitably interrupted in transplanted lun gs when removing the organs from the donor, but it can be reestablished by direct bronchial artery revascularization (BAR) during implantation. The pu rpose of this study was to visualize and quantify the distribution of bronc hial artery perfusion after en bloc double lung transplantation with BAR, b y injecting radiolabeled macroaggregated albumin directly into the bronchia l artery system. Methods: BAR was performed using the internal mammary arte ry as conduit. Patients were imaged 1 mo (n = 13) or 2 y (n = 9) after en b loc double lung transplantation with BAR. Immediately after bronchial arter iography, 100 MBq macroaggregated albumin (45,000 particles) were injected through the arteriographic catheter. Gamma camera studies were then acquire d in the anterior position. At the end of imaging, with the patient remaini ng in exactly the same position, Kr-81m-ventilation scintigraphy or convent ional intravenous pulmonary perfusion scintigraphy or both were performed. Images were evaluated by visual analysis, and a semiquantitative assessment of the bronchial arterial supply to the peripheral parts of the lungs was obtained with conventional pulmonary scintigraphy. Results: The bronchial a rtery scintigraphic images showed that the major par? of the bronchial arte rial flow supplied central thoracic structures, but bronchial artery perfus ion could also be demonstrated in the peripheral parts of the lungs when co mpared with conventional pulmonary scintigraphy. There were no differences between scintigrams obtained from patients studied 1 mo and 2 y post-transp lantation. Conclusion: Total distribution of bronchial artery supply to the human lung has been visualized in lung transplant patients. This study dem onstrates that this nutritive flow reaches even the most peripheral parts o f the lungs and is present 1 mo as well as 2 y after lung transplantation. The results suggest that bronchial artery revascularization may be of signi ficance for the long-term status of the lung transplant.