title: Noninvasive dynamic assessment with transthoracic echocardiography of a composite arterial Y-graft achieving complete myocardial revascularization.
abstract: BACKGROUND
  Composite arterial grafts are increasingly used in coronary artery bypass surgery. We assessed with transthoracic echocardiography the composite radial artery and in situ left internal thoracic artery Y-graft.
  
  
  METHODS
  In 53 of 60 consecutive patients who underwent complete myocardial revascularization using only this composite arterial graft, good transthoracic echocardiographic images and pulsed Doppler signals of the Y-graft main stem were obtained at rest and early after standard exercise. Stress/rest 99mTc-sestamibi myocardial perfusion single-photon emission computed tomography (SPECT) was the gold standard for residual myocardial ischemia. The patients with negative SPECT were divided into groups according to the number of coronary artery systems grafted, and history of preoperative myocardial infarction.
  
  
  RESULTS
  Diastolic peak velocity, diastolic velocity-time integral, the diastolic-to-systolic ratio of the peak velocities and velocity-time integrals, and the stress-to-rest ratio of the diastolic peak velocities and diastolic velocity-time integrals in the negative-SPECT patients were significantly greater than in the 6 positive-SPECT patients. Sensitivity and specificity for ischemia of the stress-to-rest ratio of the diastolic peak velocities less than 1.5 were 100%. The stress-to-rest ratio of the diastolic velocity-time integrals in the patients with three coronary systems grafted, and in those without preoperative myocardial infarction, were respectively greater than in the patients with two systems grafted (p < 0.0001), and in those with preoperative myocardial infarction (p = 0.0048).
  
  
  CONCLUSIONS
  Noninvasive dynamic assessment with transthoracic echocardiography of a composite arterial graft, including in situ left internal thoracic artery, is feasible and correlates with myocardial perfusion SPECT. The Y-graft used was able to regulate its flow capacity to myocardial demand.
authors.affiliation: Department of Cardiac Surgery, Villa Torri Hospital, Bologna, Italy. giusep.gatti@tiscali.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gatti
authors.forename: Corrado
authors.initials: C
authors.lastname: Bentini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Maffei
authors.forename: Fabio
authors.initials: F
authors.lastname: Ferrari
authors.forename: Maurizio
authors.initials: M
authors.lastname: Dondi
authors.forename: Pasqua
authors.initials: P
authors.lastname: Pacilli
authors.forename: Peppino
authors.initials: P
authors.lastname: Pugliese
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003326:Coronary Circulation; D003971:Diastole; D004452:Echocardiography; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery; D011446:Prospective Studies; D017534:Radial Artery / Q000637:transplantation*; D015899:Tomography, Emission-Computed, Single-Photon