By Carol L. Lake M.D. (auth.)

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Scintigraphic first pass, 88 % of thallium is extracted by the perfusion of the left ventricular base with little myocardium. However, only 3% of a total in- scintigraphic perfusion of the apical two thirds jected dose is localized in the myocardium, with of the left ventricle occurs in patients with trithe rest distributed to other tissues, especially ple-vessel disease (24). 5 Thallium-201 myocardial scintigraphy. Left upper frame is a 45° left anterior oblique image showing decreased thallium uptake in anteroseptal (left arrow) and posterolateral (right arrow) segments.

2. Normal half in very ill or severely cyanotic infants. ) Specific abnormalities to be expected on morphine or diazepam are given in incremental doses (68). In adults, preoperative sedation with catheterization in various disease states will be oral diazepam, 5 to 10 mg, is generally used. Ke- discussed in Chapters 5, 6, and 7. However, the tamine has been used in children, but the re- importance of the measurement of left ventricsulting increased heart rate and blood pressure, ular end-diastolic pressure must be stressed.

Cardiac Catheterization and Angiography A recent report from the Inter Society Commission for Heart Disease Resources has described the specification for radiologic and physiologic equiment, case loads, and complication rates in catheterization laboratories (49). To ensure optimum performance with the lowest complication rate, a competent operator should be performing at least 150 examinations yearly. In addition to standard catheterization and angiographic techniques described in detail below, computed tomography (CT) may be helpful in assessing intraluminal clots, graft patency, or the presence of myocardial infarction (49).

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