title: Failed coronary artery bypass anastomosis detected by intraoperative coronary flow measurement.
abstract: OBJECTIVE
  To assess intraoperative flow of arterial and venous coronary grafts after myocardial revascularization which may allow early detection of low flow situations, especially during minimally invasive coronary bypass surgery (MIDCAB), and lead to immediate correction of technical problems.
  
  
  METHODS
  In two patients with severe and diffuse multi-vessel disease the left internal mammary artery (IMA) was connected to the left anterior descending artery (LAD). During reperfusion, the flow was measured in the IMA and vein grafts using a transit time flow meter.
  
  
  RESULTS
  In both cases the IMA showed only a systolic pendulating flow curve with a mean flow of 0-1 ml/min and a high resistance. Manual IMA assessment revealed an adequate pulsation. Both distal IMA anastomoses were re-explored on cardiopulmonary bypass yielding an initial flow of 7 and 14 ml/min, respectively. After treatment with papaverine/adenosine the IMA flow increased from 7 to 26 ml/min (coronary flow reserve (CFR) = 3.7) and from 14 to 46 ml/min (CFR = 3.3), respectively.
  
  
  CONCLUSIONS
  Intraoperative flow assessment of IMA and venous bypass grafts can be recommended to monitor flow; especially during MIDCAB procedures.
authors.affiliation: Clinic for Thoracic and Cardiovascular Surgery, University of Berne, Switzerland. beat.walpoth@insel.ch
authors.forename: B H
authors.initials: BH
authors.lastname: Walpoth
authors.forename: A
authors.initials: A
authors.lastname: Bosshard
authors.forename: B
authors.initials: B
authors.lastname: Kipfer
authors.forename: P A
authors.initials: PA
authors.lastname: Berdat
authors.forename: U
authors.initials: U
authors.lastname: Althaus
authors.forename: T
authors.initials: T
authors.lastname: Carrel
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology*; D003327:Coronary Disease / Q000503:physiopathology / Q000601:surgery*; D004837:Epinephrine / Q000494:pharmacology; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010208:Papaverine / Q000494:pharmacology; D017211:Treatment Failure
chemical_list: D010208:Papaverine; D004837:Epinephrine