Abstract
Background: The successful application of noninvasive Doppler spectrum analysis has been reported for the hemodynamic assessment of LIMA graft after myocardial revascularization.
Hypothesis: The objective of this study was to assess the utility of transthoracic Doppler echocardiography (TTE) in providing information on LIMA flow in patients after coronary artery bypass graft surgery.
Methods: In all, 22 patients (aged 62 ± 8 years) with LIMA graft to the left anterior descending (LAD) coronary artery who underwent coronary angiography were assessed using high‐frequency (5 MHz) transthoracic Doppler echocardiography. They were compared with 25 patients with angina (control group A, aged 59 ± 12 years), in whom an ungrafted LIMA was assessed, and with 17 patients (control group B, aged 59 ± 9 years) with angiographically normal coronary arteries, in whom the LAD was assessed.
Results: A biphasic pattern (systolic and diastolic) was recorded in all cases. In 14 patients with a normal graft or < 70% stenosis (Group 1) and in control group B, blood flow was maximal during diastole. In eight patients with severe graft stenosis >70% (Group 2) and control group B, blood flow was maximal during systole, with low diastolic flow. The diastolic fraction of the velocity time integrals was 0.81 ± 0.11 for Group 1 and 0.25 ± 0.06 for Group 2 (p < 0.05). A diastolic velocity time integral fraction < 0.5 predicted gt; 70% stenosis with a sensitivity and specificity of 100%. The ratio of systolic/diastolic peak velocities was 0.61 ± 0.31 for Group 1 and 3.21 ± 0.49 for Group 2 (p<0.05). A systolic/diastolic peak velocity gt; 1 predicted stenosis >70% with a sensitivity and specificity of 100 and 90%, respectively.
Conclusions: High‐frequency TTE is a useful noninvasive method for detecting LIMA graft blood flow. Severe graft stenoses exhibited Doppler velocity patterns, which were different from those of patent grafts, or grafts with moderate stenoses.
Keywords: internal mammary, graft, patency, Doppler echocardiography
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References
- 1. Crowley JJ, Shapiro LM: Noninvasive assessment of left internal mammary artery graft patency using transthoracic echocardiography. Circulation 1995; 92 (suppl II): II‐25–II‐30 [DOI] [PubMed] [Google Scholar]
- 2. Acinapura AJ, Rose DM, Jacobowitz IJ, Kramer MD, Robertazzi RR, Feldman J, Zisbrod Z, Cunningham N: Internal mammary artery bypass grafting: Influence on recurrent angina and survival in 2,100 patients. Ann Thorac Surg 1989; 48: 186–191. [DOI] [PubMed] [Google Scholar]
- 3. Canver CC, Armstrong VM, Nichols RD, Mentzer RM: Color‐flow Duplex ultrasound assessment of internal thoracic artery graft after coronary bypass. Ann Thorac Surg 1995; 59: 389–392. [DOI] [PubMed] [Google Scholar]
- 4. van Son JA, Skotnicki SH, Peters MBM, Pijls NHJ, Noyez L, van Asten WN: Noninvasive hemodynamic assessment of the internal mammary artery in myocardial revascularization. Ann Thorac Surg 1993; 55: 404–409. [DOI] [PubMed] [Google Scholar]
- 5. Kyo S, Malsumura N, Yokote Y, Takamoto S, Omoto R: Evaluation of patency of internal mammary artery grafts: A comparison of two‐dimensional Doppler echocardiography and coronary angiography. J Cardiol 1990; 20: 606–616. [PubMed] [Google Scholar]
- 6. DeBono DP, Samani NJ, Spyt TJ, Hartshorne T, Thrush AJ, Evans DH: Transcutaneous ultrasound measurement of blood‐flow in internal mammary artery to coronary artery grafts. Lancet 1992; 339: 379–381. [DOI] [PubMed] [Google Scholar]
- 7. Lewis BD, James EM, Welch TJ: Current applications of duplex and color Doppler ultrasound imaging: Carotid and peripheral vascular system. Mayo Clin Proc 1989; 64: 1147–1157. [DOI] [PubMed] [Google Scholar]
- 8. Kohler TR, Nance DR, Cramer MM, Vandenburghe N, Strandness DE: Duplex scanning for diagnosis of aortoiliac and femoropopliteal disease: A prospective study. Circulation 1987; 76: 1074–1080. [DOI] [PubMed] [Google Scholar]
- 9. Ross JJ, Mints GS, Chandrasekaran K: Transthoracic two‐dimensional high frequency (7.5 MHz) ultrasonic visualization of the distal left anterior descending coronary artery. J Am Coll Cardiol 1990; 15: 373–377. [DOI] [PubMed] [Google Scholar]
- 10. Miyatake K, Yamagishi M, Lzumi S, Beppu S, Yamamoto K, Sakakibara H, Nimura Y: Doppler echocardiographic approach to the blood flow of the left anterior descending coronary artery. J Clin Ultrasound 1988; 16: 471–481. [DOI] [PubMed] [Google Scholar]
- 11. Douglas PS, Fiolkoski J, Berko B, Reichek N: Echocardiographic visualization of coronary artery anatomy in the adult. J Am Coll Cardiol 1988; 11: 565–571. [DOI] [PubMed] [Google Scholar]
- 12. Kenny A, Wisbey CR, Shapiro LM: Profiles of coronary blood flow velocity in patients with aortic stenosis and the effect of valve replacement: A transthoracic echocardiographic study. Br Heart J 1994; 71: 57–62. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Singh RH, Sosa JA: Internal mammary artery: A “live” conduit for coronary bypass. J Thorac Cardiovasc Surg 1984; 92: 88–91. [PubMed] [Google Scholar]
- 14. Fusejima K, Takabara Y, Sudo Y, Murayama II, Masuda Y, Inagaki Y: Comparison of coronary hemodynamics in patients with internal mammary artery and saphenous vein coronary artery bypass grafts: A noninvasive approach using combined two‐dimensional and Doppler echocardiography. J Am Coll Cardiol 1990; 15: 131–139. [DOI] [PubMed] [Google Scholar]
- 15. Mehta J, Pepine CJ: Effect of sublingual nitroglycerin on regional flow in patients with and without coronary disease. Circulation 1978; 58: 803–807. [DOI] [PubMed] [Google Scholar]
- 16. Feldman RL, Pepine CL, Conti CR: Magnitude of dilation of large and small coronary arteries by nitroglycerin. Circulation 1981; 64: 324–333 [DOI] [PubMed] [Google Scholar]
- 17. Hoffman JIE: Maximal coronary flow and the concept of coronary vascular reserve. Circulation 1984; 70: 153–159. [DOI] [PubMed] [Google Scholar]
- 18. Wilson RJ, White CW: Intracoronary papaverine: An ideal coronary vasodilator for studies of coronary circulation in conscious humans. Circulation 1985; 73: 444–451. [DOI] [PubMed] [Google Scholar]
- 19. Marcus M, Wright C, Doty D, Eastham C, Laughlin D, Krumm P, Fastenow C, Brody M: Measurements of coronary velocity and reactive hyperemia in the coronary vasodilation of humans. Circ Res 1981: 49: 877–891 [DOI] [PubMed] [Google Scholar]
- 20. Hiceto S, Marangelli V, Memmola C, Rizzon P: Transesophageal Doppler echocardiography evaluation of coronary blood flow velocity in baseline conditions and during dipyridamole‐induced coronary vasodilation. Circulation 1991; 83: 61–69. [DOI] [PubMed] [Google Scholar]
- 21. Kenny A, Fuller CA, Cary NRB, Shapiro IM: Histopathological vasodilation of high frequency epicardial echocardiography of the coronary arteries in vitro. Br Heart J 1991; 65: 326–331 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22. Kitamura S, Kawachi K, Seki T, Sawabata N, Morita R, Kawata T: Angiographic demonstration of no‐flow anatomical patency of internal thoracic‐coronary artery bypass grafts. Ann Thorac Surg 1992; 53: 156–159. [DOI] [PubMed] [Google Scholar]