title: Minimally invasive mammary artery Doppler flow velocity evaluation in minimally invasive coronary operations.
abstract: BACKGROUND
  Left internal mammary artery Doppler flow velocity assessment during the Azoulay maneuver (patient's legs are passively lifted up and actively maintained by the patient) can increase the information on the anastomosis quality after left internal mammary artery to left anterior descending coronary artery grafting after the left anterior, small thoracotomy operation.
  
  
  METHODS
  One hundred patients had an early postoperative angiography and a Doppler flow velocity assessment at rest and during the Azoulay maneuver. Peak and mean systolic velocities, peak and mean diastolic velocities, and peak and mean diastolic to systolic velocity ratios were recorded in all patients.
  
  
  RESULTS
  In 95 patients with no restrictive conduit or anastomosis, peak and mean diastolic to systolic velocity ratios increased during the Azoulay maneuver; all but 1 patient showed at least one ratio equal to or greater than 1. In 4 patients with restrictive conduit or anastomosis, peak and mean diastolic to systolic velocity ratios were always less than 1 during the Azoulay maneuver. In the patient with an occluded conduit these ratios were less than 0.6.
  
  
  CONCLUSIONS
  Peak and mean diastolic to systolic velocity ratios less than 1 during the Azoulay maneuver are suggestive of conduit or anastomosis malfunction. If we limit the angiographic controls to these patients, it is very likely that a pathologic anastomosis or conduit will not be missed.
authors.affiliation: Department of Cardiac Surgery, University G. D'Annunzio of Chieti, Italy. calafiore@unich.it
authors.forename: A M
authors.initials: AM
authors.lastname: Calafiore
authors.forename: S
authors.initials: S
authors.lastname: Gallina
authors.forename: A
authors.initials: A
authors.lastname: Iacò
authors.forename: G
authors.initials: G
authors.lastname: Teodori
authors.forename: T
authors.initials: T
authors.lastname: Iovino
authors.forename: G
authors.initials: G
authors.lastname: Di Giammarco
authors.forename: V
authors.initials: V
authors.lastname: Mazzei
authors.forename: G
authors.initials: G
authors.lastname: Vitolla
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011184:Postoperative Period