Patency of Saphenous Aortocoronary-Bypass Grafts Demonstrated by Computed Tomography

Moncada, Rogelio; Salinas, Matias; Churchill, Robert; Love, Leon; Reynes, Carlos J.; Demos, Terrence C; Hale, David J.; Schreiber, Ronald

doi:10.1056/nejm198008283030907

Cited by 55 publications

(18 citation statements)

References 6 publications

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“…Because of the presence of cardiac and respiratory artifacts, conventional CT has been restricted to the assessment of venous graft patency, with no possibility of detecting flowlimiting stenosis. [1][2][3][4][5] The availability in the 1990s of the spiral multislice CT (MSCT) has allowed for ECG-gated reconstruction of images, the ability to analyze arterial conduits, and detection of significant stenoses. 6 -8 Venous and arterial conduits are ideal vessels for evaluation by MSCT because of their greater diameter, their direction with reference to the plane of the cross beam, and their relative spatial fixation.…”

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confidence: 99%

Evaluation of Venous and Arterial Conduit Patency by 16-Slice Spiral Computed Tomography

et al. 2004

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Background-Computed tomography has been shown to be useful in the evaluation of aortocoronary bypass grafts (CABG). This is the first prospective study to evaluate the accuracy of a new-generation scanner in the detection of patency and significant stenoses (Ͼ50% decrease in diameter) of venous and arterial grafts in patients with previous CABG. Methods and Results-In 96 patients (80 males, mean age 62 years) with previous CABG, a multislice computed tomography (MSCT) scan was performed (collimation 16ϫ0.625 mm). Patients with atrial fibrillation, renal failure, severe respiratory disease, severe heart failure, heart rate Ͼ70 bpm despite therapy, or unstable angina were excluded. A total of 285 conduits implanted on the native coronary arteries at the time of CABG were evaluated. MSCT data were analyzed by 2 independent radiologists and compared with the results of conventional angiography. Three patients were excluded from analysis. All conduits were judged evaluable in 84 patients. Among these patients, MSCT correctly diagnosed 54 occluded grafts and 4 significant stenoses on the body of the grafts. Of the 17 significant anastomotic lesions, MSCT correctly diagnosed 15. For these 84 patients, diagnostic accuracy was 99%, sensitivity was 97%, and specificity was 100%. When all 93 patients were considered, the sensitivity of MSCT in diagnosing significant stenoses was 96%. Conclusions-MSCT with the new-generation scanner allows for accurate assessment of venous and arterial conduits in patients with previous CABG with a high degree of sensitivity and specificity. Exclusion criteria and radiation exposure remain limitations of the method.

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confidence: 99%

Evaluation of Venous and Arterial Conduit Patency by 16-Slice Spiral Computed Tomography

et al. 2004

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“…The implementation of computed tomography to detect patency of coronary bypass grafts, has first been reported in the early 1980s [3]. In the last decade, several studies showing the usefulness of 4-slice MDCT to assess bypass graft patency, demonstrated a sensitivity and specificity of 67-100% and 96-100%, respectively [4][5][6][7][8].…”

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confidence: 99%

Assessment of coronary artery bypass graft patency by multidetector computed tomography and electron-beam tomography

Piers¹,

Dorgelo

Tio³

et al. 2005

Int J Cardiovasc Imaging

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This case report describes the use of retrospectively ECG-gated 16-slice multidetector computed tomography (MDCT) and electron-beam tomography (EBT) for assessing bypass graft patency in two patients with recurrent angina after coronary artery bypass graft surgery. The results of each tomographic modality were compared to the findings of traditional coronary angiography. In the first patient MDCT showed occlusion of the left internal mammary artery (LIMA) and saphenous vein graft after the second anastomosis. Coronary angiography confirmed these findings. In the second patient EBT showed patency of the LIMA and saphenous vein graft. After the first anastomosis of the saphenous vein graft, the connected vessel filled poorly. Coronary angiography confirmed both grafts to be patent, and detected an occlusion distal to the first anastomosis. These findings support the evidence that both MDCT and EBT are suitable techniques for establishing bypass graft patency by non-invasive means.

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“…CT is the best noninvasive method for detecting graft patency. The specificity and sensitivity of conventional CT in determining saphenous vein graft patency has been demonstrated to be approximately 95 percent (20)(21)(22)(23)(24).…”

Section: Coronary Artery Bypass Graft Patencymentioning

confidence: 99%

Computed axial tomography of the heart

1985

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CT scanning provides useful cardiac imaging but has not become a routine clinical tool for heart disease due to long exposure times (2-5 seconds) and the limitation of single slice acquisition. A revolutionary high speed (Cine) CT electron beam scanner was designed at UCSF, with multilevel millisecond scanning speed at rates of 17 scans per second. Table tilt and swivel permits direct imaging in various planes including the half axis view. Images can be analysed as closed loop movies, and quantitation of wall thickening, wall mass and ejection fractions are being validated. High resolution imaging without the need for gated acquisition is a significant advantage over nuclear medicine and magnetic resonance imaging, and physiology can be studied with exercise of other interventions. Fast CT can measure vessel blood flow and has great potential for estimating myocardial perfusion using indicator dilution theory and small peripheral intravenous injection of contrast medium. Cine CT could become the noninvasive modality of choice in cardiovascular diagnosis - the scanner has universal application for all organ systems.

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Patency of Saphenous Aortocoronary-Bypass Grafts Demonstrated by Computed Tomography

Cited by 55 publications

References 6 publications

Evaluation of Venous and Arterial Conduit Patency by 16-Slice Spiral Computed Tomography

Evaluation of Venous and Arterial Conduit Patency by 16-Slice Spiral Computed Tomography

Assessment of coronary artery bypass graft patency by multidetector computed tomography and electron-beam tomography

Computed axial tomography of the heart

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