title: Flow dynamics of angiographically no-flow patent internal mammary artery grafts.
abstract: OBJECTIVE
  This study sought to assess the flow dynamics of internal mammary artery grafts (IMAGs) in no-flow situations by use of a Doppler guide wire.
  
  
  BACKGROUND
  Functionally no-flow and anatomically patent IMAGs have been reported by angiography in patients with a patent recipient coronary artery.
  
  
  METHODS
  The study included 12 patients with an IMAG to the left anterior descending coronary artery (LAD) in whom no-flow patency of the graft was suspected angiographically. Thirteen patients with a normally functioning IMAG whose LAD was occluded in the proximal portion and was supplied only from the graft served as control patients. Phasic flow velocities were recorded in the distal portion of the graft and the recipient LAD using a 0.014-in., 15-MHz Doppler guide wire at rest and during hyperemia (0.14-mg/kg body weight per min intravenous adenosine infusion).
  
  
  RESULTS
  There were no significant differences in systolic (15+/-3 vs. 19+/-6 cm/s, p = NS), diastolic (35+/-11 vs. 37+/-7 cm/s, p = NS) and time-averaged peak velocities at rest (20+/-5 vs. 21+/-5 cm/s, p = NS), during hyperemia (51+/-12 vs. 54+/-8 cm/s, p = NS) and in coronary flow velocity reserve (2.8+/-0.9 vs. 2.7+/-0.3, NS) in the native LAD in patients with a no-flow patent graft versus control patients. Within the graft, to and fro signals with systolic reversal and diastolic anterograde flow were seen in the no-flow patent grafts, although anterograde flow signals were recorded in systole and diastole in control patients. Systolic (-28+/-19 vs. 22+/-9 cm/s, p < 0.01), diastolic (18+/-17 vs. 44+/-14 cm/s, p < 0.01) and time-averaged (-2+/-6 vs. 26+/-9 cm/s, p < 0.01) peak velocities at rest were significantly smaller in the no-flow patent grafts than in control grafts. During hyperemia, anterograde flow became predominant, with a reduction in retrograde systolic flow signal and an increase in diastolic flow velocity and time-averaged peak velocity in the no-flow patent grafts, and no-flow situations disappeared temporarily.
  
  
  CONCLUSIONS
  Functionally no-flow situations of IMAGs manifesting to and fro signals with systolic flow reversal and diastolic antegrade low flow velocity are temporary conditions in certain hemodynamic circumstances, and these grafts function as conduits during hyperemic states.
authors.affiliation: Department of Cardiology, Kobe General Hospital, Japan. jse@warp.or.jp
authors.forename: T
authors.initials: T
authors.lastname: Akasaka
authors.forename: K
authors.initials: K
authors.lastname: Yoshida
authors.forename: T
authors.initials: T
authors.lastname: Hozumi
authors.forename: T
authors.initials: T
authors.lastname: Takagi
authors.forename: S
authors.initials: S
authors.lastname: Kaji
authors.forename: T
authors.initials: T
authors.lastname: Kawamoto
authors.forename: S
authors.initials: S
authors.lastname: Morioka
authors.forename: M
authors.initials: M
authors.lastname: Nasu
authors.forename: J
authors.initials: J
authors.lastname: Yoshikawa
mesh_terms: D000293:Adolescent; D000368:Aged; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000502:physiology*; D006439:Hemodynamics; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D007387:Internal Mammary-Coronary Artery Anastomosis; D008875:Middle Aged; D011184:Postoperative Period; D012039:Regional Blood Flow; D012212:Rheology / Q000295:instrumentation; D014654:Vascular Patency