title: Recovery of distal coronary flow reserve in LAD and LCx after Y-Graft intervention assessed by transthoracic echocardiography.
abstract: BACKGROUND
  Y- graft (Y-G) is a graft formed by the Left Internal Mammary Artery (LIMA) connected to the Left Anterior Descending Artery (LAD) and by a free Right Internal Mammary Artery (RIMA) connected to LIMA and to a Marginal artery of Left Circumflex Artery (LCx). Aim of the work was to study the flow of this graft during a six months follow-up to assess whether the graft was able to meet the request of all the left coronary circulation, and to assess whether it could be done by evaluation of coronary flow reserve (CFR).
  
  
  METHODS
  In 13 consecutive patients submitted to Y-G (13 men), CFR was measured in distal LAD and in distal LCx from 1 week after , every two months, up to six months after operation (a total of 8 tests for each patient) by means of transthoracic echocardiography (TTE) and Adenosine infusion (140 mcg/kg/min for 3-6 min). A Sequoia 256, Acuson-Siemens, was used. Contrast was used when necessary (Levovist 300 mg/ml solution at a rate of 0,5-1 ml/min). Max coronary flow diastolic velocity post-/pre-test > or =2 was considered normal CFR.
  
  
  RESULTS
  Coronary arteriography revealed patency of both branches of Y-G after six months. Accuracy of TTE was 100% for LAD and 85% for LCx. Feasibility was 100% for LAD and 85% for LCx. CFR improved from baseline in LAD (2.21 +/- 0.5 to 2.6 +/- 0.5, p = 0.03) and in LCx (1.7 +/- 1 to 2.12 +/- 1, p = 0.05). CFR was under normal at baseline in 30% of patients vs 8% after six months in LAD (p = 0.027), and in 69% of patients vs 30% after six months in LCx (p = 0.066).
  
  
  CONCLUSIONS
  CFR in Y-G is sometimes reduced in both left territories postoperatively but it improves at six months follow-up. A follow-up can be done non-invasively by TTE and CFR evaluation.
authors: Department of Cardiovascular Disease, Echocardiography Lab, S,Filippo Neri Hospital, Rome, Italy. a.auriti@sanfilipponeri.roma.it
authors: Antonio
authors: A
authors: Auriti
authors: Vincenzo
authors: V
authors: Loiaconi
authors: Christian
authors: C
authors: Pristipino
authors: Francesco Saverio
authors: FS
authors: Leonardi Cattolica
authors: Roberto
authors: R
authors: Cini
authors: Vincenzo
authors: V
authors: Guido
authors: Cinzia
authors: C
authors: Cianfrocca
authors: Salvatore
authors: S
authors: Greco
authors: Filomena
authors: F
authors: Agostini
authors: Mario
authors: M
authors: Staibano
authors: Massimo
authors: M
authors: Santini
mesh_terms: D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000503:physiopathology*; D004452:Echocardiography / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome