Recovery of distal coronary flow reserve in LAD and LCx after Y-Graft intervention assessed by transthoracic echocardiography

Abstract

BackgroundY- graft (Y-G) is a graft formed by the Left Internal Mammary Artery (LIMA) connected to the Left Anterior Descending Artery (LAD) and by a free Right Internal Mammary Artery (RIMA) connected to LIMA and to a Marginal artery of Left Circumflex Artery (LCx). Aim of the work was to study the flow of this graft during a six months follow-up to assess whether the graft was able to meet the request of all the left coronary circulation, and to assess whether it could be done by evaluation of coronary flow reserve (CFR).MethodsIn 13 consecutive patients submitted to Y-G (13 men), CFR was measured in distal LAD and in distal LCx from 1 week after , every two months, up to six months after operation (a total of 8 tests for each patient) by means of transthoracic echocardiography (TTE) and Adenosine infusion (140 mcg/kg/min for 3-6 min). A Sequoia 256, Acuson-Siemens, was used. Contrast was used when necessary (Levovist 300 mg/ml solution at a rate of 0,5-1 ml/min). Max coronary flow diastolic velocity post-/pre-test ≥2 was considered normal CFR.ResultsCoronary arteriography revealed patency of both branches of Y-G after six months. Accuracy of TTE was 100% for LAD and 85% for LCx. Feasibility was 100% for LAD and 85% for LCx. CFR improved from baseline in LAD (2.21 ± 0.5 to 2.6 ± 0.5, p = 0.03) and in LCx (1.7 ± 1 to 2.12 ± 1, p = 0.05). CFR was under normal at baseline in 30% of patients vs 8% after six months in LAD (p = 0.027), and in 69% of patients vs 30% after six months in LCx (p = 0.066).ConclusionCFR in Y-G is sometimes reduced in both left territories postoperatively but it improves at six months follow-up. A follow-up can be done non-invasively by TTE and CFR evaluation.

Characteristics of coronary flow velocity reserve on transthoracic Doppler echocardiography in patients with a history of Kawasaki disease

“…11 The coronary flow velocity reserve is also useful for evaluation after coronary artery bypass grafting. 12 In this study, it significantly decreased compared with that in the other groups without any significant stenotic lesions. Although the coronary artery flow of the left anterior descending artery at rest was preserved in the patients with coronary artery bypass grafting, the coronary flow velocity reserve did not necessarily improve after coronary artery bypass grafting.…”

Impact of Coronary Dominance on In-Hospital Outcomes after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome

“…Yip et al concluded that LD is related to unsuccessful reperfusion and to a higher 30-day mortality rate in LCX infarct-related acute myocardial infarction (MI) patients [21]. In addition, Auriti et al showed that coronary flow reserve was more impaired in LCX than LAD just after Y-graft intervention, which was a graft formed by the left internal mammary artery (LIMA) connected to the LAD and by a free right internal mammary artery (RIMA) connected to LIMA and a marginal artery of the LCX [22]. Clinically, a recent study showed that the 30-day prognostic outcome was less favorable in LCX-related acute inferior MI compared to RCA-related acute inferior MI [23].…”