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Titolo:
Assessment of left internal mammary artery graft patency and flow reserve alter minimally invasive direct coronary artery bypass
Autore:
Katz, WE; Zenati, M; Mandarino, WA; Cohen, HA; Gorcsan, J;
Indirizzi:
Univ Pittsburgh, Med Ctr, Div Cardiol, Pittsburgh, PA 15213 USA Univ Pittsburgh Pittsburgh PA USA 15213 Cardiol, Pittsburgh, PA 15213 USA Univ Pittsburgh, Med Ctr, Div Cardiothorac Surg, Pittsburgh, PA 15213 USA Univ Pittsburgh Pittsburgh PA USA 15213 ac Surg, Pittsburgh, PA 15213 USA
Titolo Testata:
AMERICAN JOURNAL OF CARDIOLOGY
fascicolo: 7, volume: 84, anno: 1999,
pagine: 795 - 801
SICI:
0002-9149(19991001)84:7<795:AOLIMA>2.0.ZU;2-T
Fonte:
ISI
Lingua:
ENG
Soggetto:
DOPPLER-ECHOCARDIOGRAPHY; NONINVASIVE ASSESSMENT; ADENOSINE; DIPYRIDAMOLE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
28
Recensione:
Indirizzi per estratti:
Indirizzo: Katz, WE Univ Pittsburgh, Med Ctr, Div Cardiol, Scaife Hall S563,200 Lothrop St, Pittsburgh, PA 15213 USA Univ Pittsburgh Scaife Hall S563,200 Lothrop St Pittsburgh PA USA 15213
Citazione:
W.E. Katz et al., "Assessment of left internal mammary artery graft patency and flow reserve alter minimally invasive direct coronary artery bypass", AM J CARD, 84(7), 1999, pp. 795-801

Abstract

Despite its merits, minimally invasive direct coronary artery bypass surgery (MIDCAB) has been criticized for variable left internal mammary artery (LIMA) graft patency rates, prompting the frequent use of postoperative LIMAangiography. Noninvasive transthoracic Doppler interrogation of LIMA grafts has recently been shown to have utility for assessing potency and flow: reserve after conventional bypass surgery, but data after MIDCAB has been limited. The objective of this study was to assess LIMA graft anatomy and physiology in 54 patients after MIDCAB using angiography and noninvasive LIMA Doppler imaging. The right internal mammary artery (RIMA) was studied as a control. LIMA flow reserve in response to adenosine was evaluated in a subgroup of 18 randomly chosen patients with parent grafts, LIMA angiographic patency was 93%. Forty-four patients (81%) had obtainable LIMA:Doppler data. Patent grafts had a diastolic dominant flow pattern with a peak diastolic/systolic velocity ratio of 1.3 +/- 0.6 and a percent diastolic time-velocity integral (TVI) of 70 +/- 11%. These data were significantly different than the RIMA control valves of 0.2 +/- 0.1 and 30 +/- 10%, respectively (p < 0.05). Occluded grafts had absent flow or a systolic dominant pattern. Adenosine-induced increases in LIMB peak:diastolic velocity from 48 +/- 20 to 105 +/- 28 cm/s (p < 0.05 vs baseline) and diastolic TVI from 21 +/- 10 to: 37 +/- 19 cm (p < 0.05 vs baseline), yielding adenosine/baseline ratios of 2.4 +/- 0.9 and 2.0 +/- 0.7, respectively, which was consistent with normalflow reserve. The diastolic flow velocity reserve response was inversely related to baseline diastolic flow (r = -0.69). In conclusion, MIDCAB can beassociated with a high rate of LIMA potency and favorable physiologic Doppler flow patterns. Correlation of these findings to long-term patient outcome offer MIDCAB is warranted. (C) 1999 by Excerpta Medica, Inc.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 07/04/20 alle ore 23:13:18