Detection of patency of internal mammary artery grafts to the left anterior descending artery by transthoracic Doppler echocardiography.
BACKGROUND
To determine whether a coronary artery bypass graft (CABG) is patent, we examined the flow of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) by transthoracic Doppler echocardiography (TTDE).


METHODS
Eighty-seven patients with CABG (LIMA to distal LAD) were enrolled in the study. The flows from each subject were analyzed by three criteria: mosaic flow at the anastomosis site, distal anterograde flow (ante flow), and proximal retrograde flow (retro flow).


RESULTS
On angiography, 79 grafts were patent and eight were not. TTDE study of 79 patent grafts demonstrated mosaic, ante, and retro flow in 63 (79.7%), 74 (93.7%), and 35 grafts (49.4%), respectively. The averaged diastolic peak velocity of ante flow was 26.3 +/- 11.0 cm/sec, significantly higher than that (4.8 +/- 7.1 cm/sec, P < or = 0.0001) in eight patients without patent grafts. These eight patients had no mosaic or retro flow and only three had ante flow. The accuracies to predict patency were 81.6%, 90.8%, and 49.4% for mosaic, ante, and retro flows, respectively.


CONCLUSIONS
The existence of mosaic, retro, or sufficient ante flows strongly indicated the patency of LIMA to the LAD. When symptoms are possible to be derived from the occlusion of CABG to LAD, TTDE is a promising method to examine whether a LIMA to LAD bypass is patent.
Tasaki
Hiromi
H
Second Department of Internal Medicine and Division of Cardiovascular Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishku, Kitakyushu 807-8555, Japan. h-tasaki@med.uoeh-u.ac.jp
Yamashita
Kazuhito
K
Hirakawa
Noriko
N
Suzuka
Hiroshi
H
Morishita
Tsuyoshi
T
Okazaki
Masahiro
M
Nakashima
Yasuhide
Y
Nagano
Ichiro
I
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D001783:Blood Flow Velocity; D015986:Confounding Factors, Epidemiologic; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000637:transplantation; D015150:Echocardiography, Doppler; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation; D008875:Middle Aged; D009200:Myocardial Contraction; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014654:Vascular Patency