Flow dynamics in internal thoracic artery grafts 10 years after coronary artery bypass grafting

Ichikawa, Yukio; Kajiwara, Hirokazu; Noishiki, Yasuharu; Yamazaki, Ichiya; Yamamoto, Kenji; Kosuge, Takayuki; Sato, Shin; Takanashi, Yoshinori

doi:10.1016/s0003-4975(01)03206-4

Cited by 8 publications

(6 citation statements)

References 18 publications

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“…Postoperative color Doppler ultrasonographic LITA studies revealed significant changes from preoperative data. As an adaptation to the coronary circulation, the postoperative LITA flow pattern becomes biphasic instead of triphasic, with an increased peak diastolic velocity instead of systolic pattern (10)(11)(12)(13)(14)(15)(16)(17)(18). For the LITA graft anastomosed to the LAD, postoperative data revealed that peak diastolic/systolic velocity ratio of more than 1.0 has been associated with a good angiographic finding indicating increased blood flow into the low resistance distal coronary arterial bed and probably indicating a patent graft.…”

Section: Discussionmentioning

confidence: 99%

“…Obstruction can occur between the origin of the LITA and the distal coronary bed. Proximally occluded grafts have an absence of flow and distally occluded grafts have a systolic dominant pattern (10)(11)(12)(13)(14)(15)(16)(17)(18). A poor LAD target vessel quality, competitive flow from a partially occluded proximal LAD, residual LITA side branches and the contractility and viability of the perfused myocardium can affect the Doppler flow values also.…”

Section: Study Population and Protocolmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic accuracy of Doppler ultrasonography for assessment of internal thoracic artery graft patency

Yay

Boysan²,

Ünal³

et al. 2014

Anadolu Kardiyol Derg

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Objective: The main purpose of this study was to assess the patency of left internal thoracic artery (LITA) graft by using color Doppler ultrasonography (CDUSG) and furthermore to determine the sensitivity and specificity of CDUSG for patency by using coronary angiography as the reference standard. Methods: This study is an observational cohort study on diagnostic accuracy that was held between August 2008 and October 2009. CDUSG was performed in 138 consecutive patients who had angina symptom or positive ischemic findings following coronary artery bypass surgery. LITA blood flow velocity at peak-systole (PSV), diastole (PDV) and end-diastole (EDV) was recorded. All patients were also assessed by coronary angiography for LITA graft patency. Statistical analysis was performed by using independent samples t-test, Mann-Whitney-U test, chisquare test and receiver operating curve analyses (ROC). Results: Seventy-eight of all patients had functional LITA grafts and 59 patients had dysfunctional LITA grafts according to CDUSG-derived parameters, whereas we cannot conclude about one patient's LITA graft functionality. The LITA grafts were visualized angiographically in all cases. Of all 138 patients, 60 patients had dysfunctional LITA grafts after angiographic evaluation. The ROC analyses showed that PDV (AUC=0.899, 95% CI 0.844 to 0.953; p<0.001) and EDV (AUC=0.900; 95% CI 0.847 to 0.953; p<0.001) values were also strongly associated with graft functionality. We found out that CDUSG predicts LITA graft functionality with a sensitivity and specificity of 100% and 98.4% respectively. The accuracy of the CDUSG was calculated as 99.3%. Conclusion: CDUSG is a reliable non-invasive method for assessment of LITA graft patency. (Anadolu Kardiyol Derg 2014; 14: 286-91)

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Section: Discussionmentioning

confidence: 99%

Section: Study Population and Protocolmentioning

confidence: 99%

Diagnostic accuracy of Doppler ultrasonography for assessment of internal thoracic artery graft patency

Yay

Boysan²,

Ünal³

et al. 2014

Anadolu Kardiyol Derg

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“…Meanwhile, the PI decreased according to the decrease of V max − V min and by the increase of V mean . As an adaptation to the coronary circulation, the postoperative LIMA flow pattern becomes biphasic instead of triphasic, with an increased PDV instead of systolic pattern [26, 27]. For the LIMA graft anastomosed to the LAD, postoperative data revealed that the peak diastolic/systolic velocity ratio (D/S) of more than 1.0 has been associated with a good angiographic finding indicating increased blood flow into the low resistance distal coronary arterial bed and probably indicating a patent graft [4].…”

Section: Discussionmentioning

confidence: 99%

The Role of Color Doppler Ultrasonography in the Perioperative Period of Coronary Artery Bypass Grafting: Comparison with Transit-Time Flow Measurement

et al. 2021

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Introduction: The value of color Doppler ultrasonography (CDUS) with the supraclavicular approach for preoperative evaluation of the native left internal mammary artery (LIMA) as well as for the postoperative detection of LIMA graft patency was recently suggested. However, the parameters such as the flow volume and pulsatile index (PI) have not been studied in detail. Objectives: The objectives of this study were to analyze the LIMA data in the perioperative period and explore the relationships between the intraoperative graft flow with transit-time flow measurement (TTFM) and the postoperatively measured parameters with CDUS. Methods: Fifty-eight patients with significant stenosis (≥70%) or occlusions in left anterior descending artery (LAD) who were referred for isolated coronary artery bypass grafting (CABG) were enrolled in this study and examined by CDUS prior to CABG from April to July 2016. The perioperative measurements of proximal LIMA by CDUS were compared. In addition, the correlation between the intraoperative graft flow, such as the mean graft flow (MGF) and PI, and the immediate postoperative measurements of CDUS in LIMA bypassed grafts was statistically analyzed. Results: Six patients were excluded due to screening failure, or insufficient visualization of CDUS images for analysis. Fifty-two patients with in situ LIMA-LAD graft, with or without additional arterial grafts or saphenous vein grafts, were included in the final analysis. The postoperative diameters of proximal LIMA were not significantly different from preoperative diameters (2.21 ± 0.18 vs. 2.27 ± 0.22 mm, p = 0.070). The flow volume on the early postoperative CDUS significantly increased (39.77 ± 21.59 vs. 25.96 ± 13.17 mL/min, p < 0.001) and the PI significantly decreased (1.43 ± 0.46 vs. 4.20 ± 1.49, p < 0.001) versus those of preoperative measurements. The MGF had a moderate correlation with the flow volume on the early postoperative CDUS (r = 0.414, p = 0.002), and the PI by TTFM had a weak correlation with that by CDUS (r = 0.353, p = 0.010) as well. Conclusions: The MGF and PI by TTFM in CABG were associated with in situ LIMA graft parameters measured by CDUS studies. CDUS is a useful functional noninvasive tool for the preoperative screening and postoperative follow-up of patients with in situ LIMA bypass.

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“…Limitations of control arteriography are its costs, risks in clinically stable patients of 0.7-4.0%, and the possible disruption of baseline hemodynamics by contrast injection. [20] The cardiac markers measured repetitively would possibly give a reasonable evaluation of the release. However, Sadony et al [11] stated that a cardiac troponin I value at 24 hours had a sensitivity of 100% and a specificity of 97% for discrimination of patients with or without MI.…”

Section: Discussionmentioning

confidence: 99%

A prospective study on indication of intracoronary shunt during off-pump coronary bypass grafting surgery for single-vessel disease

Tüfekçi¹

2016

Turk Gogus Kalp Dama

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Bu çalışmada damarda retrograd akım olan ve olmayan sol ön inen arter lezyonu olan hastalarda atan kalpte koroner arter baypas cerrahisi sırasında intrakoroner şant kullanımının faydalı olup olmadığı araştırıldı. Ça lış ma pla nı: Nisan 2007-Mart 2014 tarihleri arasında kliniğimizde atan kalpte koroner arter baypas cerrahisi ile tedavi edilen toplam 80 hasta (54 erkek, 26 kadın; ort. yaş 61.9 yıl; dağılım 36-82 yıl) çalışmaya dahil edildi. Hastaların yarısında anjiyografik olarak gösterilmiş tıkalı (%100) sol ön inen arter hastalığı varken diğer yarısında tam tıkalı olmayan (%70-99) sol ön inen arter hastalığı vardı. Bu hastalar tıkanıklık derecesi ve intrakoroner şant kullanımına göre dört gruba randomize edildi. Gruplar; anastomoz süresi, troponin I, kreatinin kinaz ve kreatinin kinaz miyokardiyal izoenzimi serum düzeyleri açısından karşılaştırıldı. Bul gu lar: İntrakoroner şant kullanılan gruplarda ameliyat sonrası kreatinin kinaz miyokardiyal izoenzimi ve troponin düzeyleri anlamlı derecede düşük idi. Buna karşın, şant kullanılan ve kullanılmayan gruplarda ameliyat öncesi kreatinin kinaz miyokardiyal izoenzimi, troponin düzeyleri ve ameliyat öncesi ve sonrası kreatinin kinaz düzeyleri açısından farklılık yoktu. So nuç: İntrakoroner şant özellikle anatomik zorlukları ve kritik hastalığı olan hastalarda önerilebilir. Atan kalpte koroner arter baypas greft cerrahisinde intrakoroner şantların endikasyonlarını ortaya koyacak ileri klinik çalışmalara ihtiyaç vardır. Anah tar söz cük ler: Koroner baypas cerrahisi; miyokardiyal yaralanma; atan kalpte koroner arter baypas greft cerrahisi; şant.

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Flow dynamics in internal thoracic artery grafts 10 years after coronary artery bypass grafting

Cited by 8 publications

References 18 publications

Diagnostic accuracy of Doppler ultrasonography for assessment of internal thoracic artery graft patency

Diagnostic accuracy of Doppler ultrasonography for assessment of internal thoracic artery graft patency

The Role of Color Doppler Ultrasonography in the Perioperative Period of Coronary Artery Bypass Grafting: Comparison with Transit-Time Flow Measurement

A prospective study on indication of intracoronary shunt during off-pump coronary bypass grafting surgery for single-vessel disease

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