title: [Evaluation of flow reserve in internal mammary artery in situ bypass].
abstract: The internal mammary artery, when used as a conduit for coronary artery bypass, offers a better long-term patency and survival rate than the saphenous vein. However, concern exists that the flow through the internal mammary artery may be inadequate during periods of peak myocardial demand. This flow was investigated in 18 consecutive patients who were selected for coronary bypass of the left anterior descending artery using the internal mammary artery. All patients were evaluated post-operatively within 12 months by means of graded maximal stress test, cardiac catheterization and exercise thallium-201 scintigraphy. Significant improvement in work capacity, maximal rate-pressure product, effort angina and ECG abnormalities during exercise stress testing were observed following internal mammary artery myocardial revascularization. The patency rate for internal mammary artery grafts was 100% (vs 85% for vein grafts); during the followup period, occlusion of a saphenous vein bypass or development of a new stenosis in a native coronary artery was noted in five patients, and two patients were classified as having partial revascularization. Ischemia, demonstrated by perfusion deficits at peak stress which disappeared in the 3-hour delayed film, was documented in 7.4% (4/54) of the areas supplied by internal mammary artery grafts, compared to 31% (13/42) of the regions revascularized using saphenous vein conduits. Although this result was not statistically significant, a definite trend is suggested. We conclude that ischemia demonstrated by stress thallium scintigraphy in the post-operative period is uncommon when an internal mammary artery graft has been used. This suggests that adequate coronary flow exists at peak myocardial demand during exercise.
authors.affiliation: Divisione di Cardiologia, Ospedale Civile, Cittadella, Padova.
authors.forename: M
authors.initials: M
authors.lastname: Zanchetta
authors.forename: J
authors.initials: J
authors.lastname: Dalle Mule
authors.forename: C
authors.initials: C
authors.lastname: Di Mario
authors.forename: R
authors.initials: R
authors.lastname: Perelli
authors.forename: R
authors.initials: R
authors.lastname: Carlon
authors.forename: U
authors.initials: U
authors.lastname: De Lio
authors.forename: B
authors.initials: B
authors.lastname: Branchini
authors.forename: B
authors.initials: B
authors.lastname: Zingone
authors.forename: P
authors.initials: P
authors.lastname: Maiolino
mesh_terms: D000368:Aged; D000792:Angiography; D017023:Coronary Angiography; D003326:Coronary Circulation; D005069:Evaluation Studies as Topic; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011184:Postoperative Period; D011877:Radionuclide Imaging; D013794:Thallium Radioisotopes
chemical_list: D013794:Thallium Radioisotopes
vernacular_title: Valutazione della riserva di flusso dei bypass con arteria mammaria interna in situ.