title: Assessment of internal thoracic artery patency with transesophageal echocardiography during coronary artery bypass graft surgery.
abstract: OBJECTIVE
  The purpose of this study was to evaluate intraoperative transesophageal echocardiography (TEE) for assessing patency of internal thoracic artery grafts.
  
  
  METHODS
  A retrospective study.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  Fifty-one consecutive patients who underwent coronary artery bypass graft (CABG) surgery using the left internal thoracic artery (LITA)-to-left coronary artery were examined postoperatively with coronary angiography (CAG).
  
  
  METHODS
  None.
  
  
  RESULTS
  The authors measured blood flow velocity using TEE after anastomosis of a LITA graft. Intraoperative TEE findings and routine CAG results were compared to evaluate the quality of TEE assessment. The LITA was detected in 45 of 51 patients (88%) intraoperatively with TEE. Peak and mean velocities and velocity time integral ratios were determined by dividing each diastolic value by its corresponding systolic value. The peak velocity ratio was 0.51 +/- 0.04 (range, 0.40-0.59) in the presence of stenosis and 1.14 +/- 0.10 (range, 0.58-3.87) in its absence (p = 0.0289), whereas mean velocity ratios were 0.62 +/- 0.05 (range, 0.45-0.72) and 1.27 +/- 0.10 (range, 0.66-4.08) (p = 0.0223), respectively, and velocity time integral ratios were 0.83 +/- 0.09 (range, 0.64-1.05) and 2.69 +/- 0.29 (range, 0.91-8.35) (p = 0.0224), respectively. The critical values for peak and mean velocities and velocity time integral ratios were 0.60, 0.73, and 1.06, respectively, whereas the sensitivity for each was 100% and the specificity was 92%, 94%, and 89%, respectively.
  
  
  CONCLUSIONS
  The authors concluded that the intraoperative assessment of LITA patency with TEE was a markedly useful and powerful tool for anesthesiologists during CABG surgery.
authors.affiliation: Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan. kurodam@hiroshima-u.ac.jp
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kuroda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hamada
authors.forename: Masashi
authors.initials: M
authors.lastname: Kawamoto
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Orihashi
authors.forename: Taijiro
authors.initials: T
authors.lastname: Sueda
authors.forename: Masaya
authors.initials: M
authors.lastname: Otsuka
authors.forename: Osafumi
authors.initials: O
authors.lastname: Yuge
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging* / Q000601:surgery; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014654:Vascular Patency