Transcutaneous ultrasound measurement of blood-flow in internal mammary artery to coronary artery grafts

Bono, David P. de; Samani, Nilesh J.; Spyt, T J; Hartshorne, T.; Thrush, Abigail; Evans, David H.

doi:10.1016/0140-6736(92)90076-f

Cited by 83 publications

(43 citation statements)

References 5 publications

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“…Noninvasive visualization of LIMA graft has been attempted in previous studies; 5,6 however, imaging of the proximal and mid-LIMA using parasternal and supraclavicular approaches has a low detection rate (55%). These studies used higher frequency (7.5 MHz) transducers than those used in this study, which may have greater tissue attenuation.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of Left Internal Mammary Artery Graft Patency by Transthoracic Doppler Echocardiography

Elmasry

Salama

Darwish

et al. 2002

Clinical Cardiology

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SummaryBackground: The successful application of noninvasive Doppler spectrum analysis has been reported for the hemodynamic assessment of LIMA graft after myocardial revascularization.Hypothesis: The objective of this study was to assess the utility of transthoracic Doppler echocardiography (TTE) in providing information on LIMA flow in patients after coronary artery bypass graft surgery.Methods: In all, 22 patients (aged 62 ± 8 years) with LIMA graft to the left anterior descending (LAD) coronary artery who underwent coronary angiography were assessed using high-frequency (5 MHz) transthoracic Doppler echocardiography. They were compared with 25 patients with angina (control group A, aged 59 ± 12 years), in whom an ungrafted LIMA was assessed, and with 17 patients (control group B, aged 59 ± 9 years) with angiographically normal coronary arteries, in whom the LAD was assessed.Results: A biphasic pattern (systolic and diastolic) was recorded in all cases. In 14 patients with a normal graft or < 70% stenosis (Group 1) and in control group B, blood flow was maximal during diastole. In eight patients with severe graft stenosis > 70% (Group 2) and control group B, blood flow was maximal during systole, with low diastolic flow. The diastolic fraction of the velocity time integrals was 0.81 ± 0.11 for Group 1 and 0.25 ± 0.06 for Group 2 (p < 0.05). A diastolic velocity time integral fraction < 0.5 predicted > 70% stenosis

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Section: Discussionmentioning

confidence: 99%

“…6,15,16 The functional impairment of a vessel is probably better assessed by measuring flow reserve. Invasive studies have shown that when maximal coronary dilatation is induced, blood flow or blood flow velocity increases more in normal vessels than in those affected by significant stenosis.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Left Internal Mammary Artery Graft Patency by Transthoracic Doppler Echocardiography

Elmasry

Salama

Darwish

et al. 2002

Clinical Cardiology

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“…In [15][16][17][18][19][20][21][22] Schumacher [36] published a study demonstrating the induction of angiogenesis in a ischemic human myocardium, a conduct that is increasingly being considered for patients who are not candidates for direct or percutaneous revascularization.…”

Section: Commentsmentioning

confidence: 99%

“…In works published between 1992 and 2001, De Simone et al [15], Chirillo et al [20], De Bono et al [21] and Van Son et al [22] demonstrated successful detection of the LITA in 100% of the cases.…”

Section: Introductionmentioning

confidence: 99%

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Vineberg Procedure by "Vineberg technique modified by Lobo Filho": morbidity and mortality in the imediate post operative period, angiography results and flow analyze of the left internal thoracic artery implanted

Filho¹,

Leitão²,

Filho³

et al. 2003

Rev Bras Cir Cardiovasc

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Transient reversal of blood flow in an internal thoracic artery to coronary artery graft during syncope

Mauric

Samani

Bono

1994

Clinical Cardiology

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Summary:Transcutaneous duplex ultrasound can be used to image and quantify blood flow in the proximal part of the internal thoracic artery to coronary artery bypass grafts. ' In addition to providing information about graft patency and blood flow for follow-up purposes, the technique also provides an opportunity to study the physiology and pharmacology of the coronary circulation. In this paper we describe and attempt to interpret an unusual pattern of internal thoracic artery graft blood flow observed during inadvertent nitrate-induced syncope.Key words: internal thoracic artery graft, Doppler ultrasound, coronary flow, syncope Case ReportThe patient was a46-year-old man who was talung part in a study investigating the effects of glyceryl trinitrate on internal thoracic artery graft flow. This study had previously been approved by the local ethics of medical research subcommittee.A year previously he had undergone coronary bypass graft surgery at which a saphenous vein graft had been made to the posterior descending coronary artery, and the left internal thoracic artery had been anastomosed to the distal left anterior descending coronary artery, which was occluded proximally.The patient had been angina-free since the time of the surgery and his sole medication was aspirin 75 mg daily. Ultrasound examination was carried out as previously described' using a Diasonics ultrasound system with a 5 MHz flat linear probe and color Doppler facility. Volume blood flows were derived from the Doppler sonogram by multiplying the time averaged velocity (TAV) of blood flow by the cross-sectional area of the graft. Systole and diastole were inferred both from the simultaneously recorded electrocardiogram and from the shape of the Doppler sonogram, which was compared with phonocardiographic measurements in previous studies.The internal thoracic artery was readily located and the initial sonogram showed the characteristic biphasic flow pattern of a patent graft (Fig. 1). Graft diameter was 2.4 mm, total blood flow 56 mYmin, systolic flow 18 d m i n , diastolic flow 38 mY min. Blood pressure was 117/77. These values remained stable through four repeat measurements over a 20-min period. Exercise (straight leg raising) was then undertaken over a 5-min period, and blood pressure rose to 138/76. Graft flow also increased to 91 d m i n (39 d m i n systole, 52 mumin diastole). Over a 10-min rest period blood pressure returned to 12477 and graft flow to 59 d m i n . Glyceryl trinitrate 500 pg was administered sublingually and after 3 min the patient complained of dizziness; his blood pressure fell to 64/32 and his heart rate remained at 76 beatdmin. The patient was already lying supine. His legs were immediately elevated, while the ultrasound examination continued. There was a dramatic decrease in total grafl blood flow to 20.6 mumin and both systolic and diastolic components showed terminal flow reversal (Fig. 2). The first part of systole (AB) lasted 130 ms and had a forward flow of 5.87 mumin, the second half of systole also lasted 1...

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Transcutaneous ultrasound measurement of blood-flow in internal mammary artery to coronary artery grafts

Cited by 83 publications

References 5 publications

Assessment of Left Internal Mammary Artery Graft Patency by Transthoracic Doppler Echocardiography

Assessment of Left Internal Mammary Artery Graft Patency by Transthoracic Doppler Echocardiography

Vineberg Procedure by "Vineberg technique modified by Lobo Filho": morbidity and mortality in the imediate post operative period, angiography results and flow analyze of the left internal thoracic artery implanted

Transient reversal of blood flow in an internal thoracic artery to coronary artery graft during syncope

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