Which radiopharmaceuticals may be used for a left-to-right cardiac shunt exam?

The correct choice for this question is the option that includes pentetate, pertechnetate, sestamibi, or tetrofosmin. These radiopharmaceuticals are utilized in evaluating left-to-right cardiac shunts due to their properties and biological behaviors.

Pentetate (often referred to as DTPA) is a radiopharmaceutical that is key for imaging and assessing blood flow dynamics, particularly in cardiac evaluations, as it can reveal the presence of shunts by circulating through both systemic and pulmonary circulation.

Pertechnetate is also valuable for this purpose, as it is taken up by different tissues, including the thyroid and gastric mucosa, and its transit through the heart can indicate abnormal flow patterns linked to shunts.

Sestamibi and tetrofosmin, both of which are used in myocardial perfusion imaging, have the ability to demonstrate regional blood flow differences and can also assist in identifying left-to-right shunting by highlighting areas of increased flow or “reversal” due to shunting.

Combining these four agents allows for a comprehensive assessment of cardiac function and the identification of shunts, making this option the most appropriate for the examination of left-to-right cardiac shunts.