Noninvasive evaluation of arterial grafts with newly released multidetector computed tomography.
BACKGROUND
High-quality postoperative imaging of bypass conduits is essential when evaluating different types of conduits, anastomoses, and surgical techniques. We investigated the potential value of the newest generation of multidetector-row computer tomographic scanners in assessing bypass grafts.


METHODS
From June to September 2002, 14 patients underwent scanning with a newly released 16-slice computed tomographic scanner (Mx8000 IDT; Philips Medical Systems) after coronary artery bypass grafting. Four patients had had minimally invasive direct coronary artery bypass grafting and 3, redo coronary artery revascularization. Contrast-enhanced computed tomographic angiography was performed using retrospective electrocardiographic gating. Scan length was 22 to 30 cm, and total scan time was 27 to 37 seconds.


RESULTS
Of the 14 patients, 8 were scanned within 1 week after operation and 6, 1 month to 12 months postoperatively. Average heart rate during the scan was 82 beats per minute (range, 60 to 97 beats per minute), and all patients were able to hold their breath for the required time. Thirty conduits were studied: 26 arterial (18 in situ left and right internal mammary artery grafts, five free right internal mammary and radial artery grafts, and three in situ right gastroepiploic artery grafts) and four vein grafts. Excellent visualization of all 30 grafts was achieved. Thirty-four of the 35 distal anastomoses were patent; one vein graft was occluded.


CONCLUSIONS
This new technology is a promising noninvasive measure to evaluate patency of bypass conduits, including the gastroepiploic artery where catheterization is usually difficult. The ability to display the vessel wall as well as its lumen might distinguish radial artery spasm from intimal hyperplasia. The superb resolution and increased scan length required to cover the entire internal mammary artery grafts-from origin to distal anastomoses-can be achieved easily in a single breath-holding owing to the increased number of slices per rotation and shortening of the gantry rotation time.
Gurevitch
Jacob
J
Department of Thoracic and Cardiovascular Surgery, The Lady Davis Carmel Medical Center, affiliated to the Rappaport Faculty of Medicine, Technion-Haifa, Israel. nettag@barak-online.net
Gaspar
Tamar
T
Orlov
Boris
B
Amar
Ron
R
Dvir
Dan
D
Peled
Nathan
N
Aravot
Dan J
DJ
D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D014654:Vascular Patency / Q000502:physiology