title: Intraoperative color Doppler ultrasound assessment of anastomoses of the left internal mammary artery to the left anterior descending coronary artery during off-pump coronary artery bypass surgery correlates with angiographic evaluation at the 8-month follow-up.
abstract: OBJECTIVE
  This study was performed to evaluate the correlation between intraoperative color Doppler ultrasound assessment of anastomoses of the left internal mammary artery (LIMA) to the left anterior descending coronary artery (LAD) performed on the beating heart and the angiographic assessment after 8 months.
  
  
  METHODS
  Twenty patients (M/F ratio, 14:6; mean age, 62 +/- 8 years) underwent epicardial color Doppler ultrasound imaging with a 10-MHz linear array GE Vingmed transducer combined with a GE Vingmed System FiVe. Transit-time flowmetry was used as intraoperative control. Follow-up coronary angiography after a median of 245 days (range, 128-320 days) allowed assessment of thrombolysis in myocardial infarction (TIMI) flow and FitzGibbon grading in all patients. Detailed quantitative coronary angiography was performed in 10 patients with an emphasis on comparing the LAD diameter at the toe of the anastomosis (D1) and in the downstream LAD (D2).
  
  
  RESULTS
  Intraoperative ultrasound analysis revealed 19 patent LIMA-LAD anastomoses (95%). A >50% stenosis was detected in 1 anastomosis (5%), which was subsequently revised successfully. Follow-up angiographic evaluation showed TIMI-III flow and FitzGibbon grade A in 18 of 20 anastomoses (90%). One anastomosis was occluded, and one had FitzGibbon grade B stenosis. The D1/D2 ratios of the LAD measurements assessed with intraoperative ultrasound and follow-up quantitative coronary angiography were significantly correlated (r2 = 0.62; P < .01).
  
  
  CONCLUSIONS
  Intraoperative color Doppler ultrasound allows a detailed evaluation of LIMA-LAD anastomoses during off-pump surgery, and the results correlate significantly with those of angiographic evaluation after 8 months. The present study shows that epicardial ultrasound is a promising tool for verification of LIMA-LAD anastomoses performed on the beating heart and may reduce the risk of impaired graft flow caused by technical errors.
authors.affiliation: St. Elisabeth Heart Center and Institute of Circulation and Imaging Techniques, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Ole
authors.initials: O
authors.lastname: Tjomsland
authors.forename: Rune
authors.initials: R
authors.lastname: Wiseth
authors.forename: Alexander
authors.initials: A
authors.lastname: Wahba
authors.forename: Arve
authors.initials: A
authors.lastname: Tromsdal
authors.forename: Stein O
authors.initials: SO
authors.lastname: Samstad
authors.forename: Rune
authors.initials: R
authors.lastname: Haaverstad
mesh_terms: D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D016014:Linear Models; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging; D008875:Middle Aged; D018615:Ultrasonography, Doppler, Color