Assessment of internal thoracic artery graft with intraoperative color doppler ultrasonography

Oda, Katsushi; Hirose, Katsumi; Nishimori, Hideaki; Sato, Koji; Yamashiro, Toshiyuki; Ogoshi, Shohei

doi:10.1016/s0003-4975(98)00317-8

Cited by 19 publications

(8 citation statements)

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“…Transducer size gradually decreased from rod-shaped transducers as large as 24 9 2.5 cm that were used in the pioneering 1980s studies [2][3][4] to (mini-) transducers as small as 1.5 9 0.9 9 0.6 cm [10,12,13,[15][16][17][20][21][22][23][24][25][26][27][28][29][30] (Fig. 1A).…”

Section: Transducer Sizementioning

confidence: 99%

High-frequency epicardial ultrasound: review of a multipurpose intraoperative tool for coronary surgery

et al. 2008

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Background In open-chest coronary artery bypass grafting (CABG), the surgeon faces several intraoperative challenges: (1) to locate the target coronary artery, (2) to select the optimal anastomotic site, and (3) to assess the quality of the graft and distal anastomosis. Endoscopically, these three diagnostic aims are particularly challenging. Methods We reviewed the literature on the intraoperative application of high-frequency (6.5-15 MHz) epicardial ultrasound (ECUS) in CABG to aid in these challenges. Results Overall, ECUS was used in 628 patients to visualize and assess 912 (segments of) coronary arteries, as well as 418 grafts and distal anastomoses. In 96 cases, ECUS successfully located a coronary artery that was buried in the epicardial and/or myocardial tissue. In 37/155 (24%) imaged anastomotic sites, an alternative site free of pathology was selected. For quality assessment of the coronary anastomosis, experimental validation of ECUS included 218 anastomoses in ex vivo and animal models. ECUS showed high sensitivity (0.98) and specificity (1.00) for detection of anastomotic construction errors in 120 ex vivo anastomoses. In 418 grafts and distal anastomoses evaluated in patients, irregularities leading to revision were detected in 8 (1.9%) anastomoses and minor irregularities in an additional 23 (5.5%) anastomoses. However, little is known about the effect on long-term patency of specific anastomotic abnormalities revealed by ECUS. Scanning of arteries and anastomoses required several minutes. Current size ultrasound probes allowed successful experimental robot-assisted endoscopic application of ECUS. Conclusions CABG may be facilitated and improved in several ways by intraoperative high-frequency epicardial ultrasound scanning. Totally endoscopic CABG may benefit from ultrasound diagnostics in particular.

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Section: Transducer Sizementioning

confidence: 99%

High-frequency epicardial ultrasound: review of a multipurpose intraoperative tool for coronary surgery

et al. 2008

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“…We placed sterilized jelly between the ITA graft and the transducer for clear visualization. The graft flow pattern obtained consisted of 2 phases of flow corresponding to systole and diastole, as reported previously [1][2][3][4][5] and shown in Table 1. All parameters of ITA flow showed an increase by 2-fold or more compared with before repair, except for peak diastolic-to-systolic velocity ratio, mean diastolic-to-systolic velocity ratio and diastolic fraction, which were almost the same as before repair.…”

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confidence: 72%

“…Oda et al measured ITA graft flow by intraoperative ultrasonography and reported that the peak systolic velocity and peak diastolic velocity were 52.0±14.9 cm/s and 58.3±22.4 cm/s respectively. 1 Because the site of measuring ITA graft flow in the present study was immediately distal to the stenosis, augmentation of flow velocity was sometimes observed, and it is possible that our intraoperative measurement before repair might have been overestimated. Despite that, compared with the data from the study by Oda et al, our values before repair were less than half of their average values and after repair these values resumed the average.…”

Section: Circulation Journal Vol69 February 2005mentioning

confidence: 83%

“…[1][2][3][4][5] A decreased diastolic velocity time integral fraction 2,3 (<0.5) or a decreased peak diastolic-to-systolic velocity ratio 2-5 (<0.6-1.0) predicts severe graft stenosis, but in the present case, the diastolic velocity time integral fraction was more than 0.5 and the ratio of diastolic-tosystolic peak velocity was more than 1.0 before repair. The probable explanation for this discrepancy is that the previous study population only included patients with a distal stenosis of the ITA, so the diagnostic criteria are not appropriate for ITA grafts with ostial stenosis.…”

Section: Circulation Journal Vol69 February 2005mentioning

confidence: 90%

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Impact of Ostial Stenosis on the Doppler Flow Profiles in Internal Thoracic Artery Graft

Yoshitatsu

Nomura

Izutani

et al. 2005

Circ J

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everal studies have reported that evaluation of graft patency by transthoracic Doppler echocardiography (TTDE) is useful in patients who undergo left internal thoracic artery (ITA) to left anterior descending coronary artery (LAD) bypass, 1-5 but as those reports did not include patients with ITA proximal stenosis, little is known about the Doppler flow profile in such grafts. We performed surgical repair of a left ITA (LITA) graft proximal stenosis after coronary artery bypass grafting (CABG) and report the changes in the Doppler flow profile of the graft after repair of proximal stenosis using intraoperative ultrasonography. Case ReportA 54-year-old male patient underwent elective CABG in June 2000, in which the LITA was anastomosed to the LAD segments 7 and 8 sequentially, the free right ITA to the distal circumflex and first diagonal branch of the left coronary artery sequentially, and the right gastroepiploic artery to segment 4PD of the right coronary artery. The follow-up coronary angiography in January 2001 revealed no ostial stenosis of the LITA graft. Soon after, the patient developed effort angina, so coronary angiography was repeated in July 2001 and a 90% ostial stenosis of the LITA was detected. He underwent surgical intervention, including stent implantation to this lesion 5 times. For a while the symptoms were relieved, but recurrent effort angina developed. The latest coronary angiography examination revealed 90%Circulation Journal Vol. 69, February 2005 stenosis in the stent implanted to the ITA with total occlusion in the proximal LAD ( Fig 1A). It also showed good run-off in the distal LAD. Scintigraphy showed reversible ischemia in the anteroseptal region. Surgical repair of the LITA proximal stenosis was recommended and the patient underwent elective surgery. The left radial artery was taken down in a skeletonized fashion. An arterial catheter was inserted in the femoral artery for continuous coronary artery perfusion. Left lateral thoracotomy was performed because median sternotomy was thought to have a risk of injuring the LITA graft, which was the main vessel perfusing the LAD region. An ultrasonographic probe was attached to the ITA directly and Doppler signals of ITA flow were recorded (Fig 2A). The measurement site was in the middle portion of the ITA graft. Intraoperative ultrasonography was performed with a 7.5 MHz linear array transducer that had been sterilized and connected to an Aloka SSD 5500 Prosound ultrasound system. We placed sterilized jelly between the ITA graft and the transducer for clear visualization. The graft flow pattern obtained consisted of 2 phases of flow corresponding to systole and diastole, as reported previously 1-5 and shown in Table 1. All parameters of ITA flow showed an increase by 2-fold or more compared with before repair, except for peak diastolic-to-systolic velocity ratio, mean diastolic-to-systolic velocity ratio and diastolic fraction, which were almost the same as before repair.After dissecting out the LITA for the anastomosis, it was cut dow...

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“…Η λειτουργία του μοσχεύματος της ΕΘΑ ήταν ικανο ποιητική όταν η διαστολική ταχύτητα υπερτερούσε της συστολικής. 95 Η διαστολική ταχύτητα ήταν μεγαλύτερη της συστολικής περιφερικότερα της μεσότητας της ΕΘΑ. Αντίθετα, όσο πιο κεντρικά, τόσο η συστολική ροή ή ταν μεγαλύτερη, και έμοιαζε με τη ροή της ΕΘΑ στη φυσική της θέση.…”

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Μεταβολή Του Αγγειακού Αρτηριακού Τόνου Μετά Ενδοφλέβια Χορήγηση Αποκλειστή Ασβεστίου Σε Καρδιοχειρουργικούς Αρρώστους

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Η ιστορία και η εξέλιξη της χρησιμοποίησης των αρτηριακο3ν μο σχευμάτων στην καρδιοχειρουργική Η ανατομία της στεφανιαίας κυκλοφορίας και η ανατομία και ιστοπαθολογίατης ΚΑκαιτης ΕΘΑ 21 Φυσιολογία της ρύθμισης της αιματικής ροής της στεφανιαίας κυ κλοφορίας Η βιολογία των αρτηριακών μοσχευμάτων: το ενδοθήλιο, η λεία μυϊ κή ίνα και η αγγειοκινητική συμπεριφορά Η φαρμακευτική αντιμετώπιση του αγγειόσπασμου των αρτηριακών μοσχευμάτων Η ποσοτική και ποιοτική ροή των μοσχευμάτων και οι μέθοδοι μέ τρησης Η βατότητα των μοσχευμάτων της ΕΘΑ και ΚΑ 49 Η φαρμακολογία των ουσιών που χρησιμοποιήθηκαν στη μελέτη ... Το ροόμετρο μεταβολής χρόνου (transit-time) ΕΙΔΙΚΟ ΜΕΡΟΣ Υλικό Αναισθητική τεχνική Εγχειρητική τεχνική Ερευνητικό πρωτόκολλο Στατιστική ανάλυση

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Assessment of internal thoracic artery graft with intraoperative color doppler ultrasonography

Cited by 19 publications

References 8 publications

High-frequency epicardial ultrasound: review of a multipurpose intraoperative tool for coronary surgery

High-frequency epicardial ultrasound: review of a multipurpose intraoperative tool for coronary surgery

Impact of Ostial Stenosis on the Doppler Flow Profiles in Internal Thoracic Artery Graft

Μεταβολή Του Αγγειακού Αρτηριακού Τόνου Μετά Ενδοφλέβια Χορήγηση Αποκλειστή Ασβεστίου Σε Καρδιοχειρουργικούς Αρρώστους

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