Two-year assessment by exercise Thallium scintigraphy of myocardial revascularization using bilateral internal mammary and gastroepiploic arteries
| Autor: | Philippe Mikaeloff, Christian Chatel, Roland Itti, Guy de Gevigney, Olivier Jegaden, Laurence Bontemps |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.medical_treatment Myocardial Ischemia Ischemia Gastroepiploic Artery Anterior Descending Coronary Artery Scintigraphy Revascularization Angina Pectoris Electrocardiography Coronary artery bypass surgery medicine.artery Internal medicine medicine Humans Prospective Studies cardiovascular diseases Coronary Artery Bypass Mammary Arteries Aged Tomography Emission-Computed Single-Photon medicine.diagnostic_test business.industry Stomach Heart Arteries General Medicine Middle Aged medicine.disease Surgery Thallium Radioisotopes medicine.anatomical_structure Right coronary artery Exercise Test Cardiology Female Cardiology and Cardiovascular Medicine business Omentum Follow-Up Studies Artery |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 16:131-134 |
| ISSN: | 1010-7940 |
| DOI: | 10.1016/s1010-7940(99)00160-8 |
| Popis: | Objective: To assess the blood flow supply offered to the myocardium by surgical revascularization using bilateral internal mammary (IMAs) and gastroepiploic (GEA) arteries. Methods: Two-year assessment by exercise thallium myocardial scintigraphy without medical treatment was performed in 122 patients (mean age 61 ^ 9 years) who underwent coronary artery bypass grafting (CABG) with exclusive use of IMAs and GEA. Usually, the right IMA was used to bypass the left anterior descending coronary artery, and the left IMA to bypass the diagonal and the marginal arteries as a sequential graft if required. The GEA was used to bypass the right coronary artery (RCA) in 50 patients and its posterior branches in 72 patients. Results: During maximal or submaximal exercise stress testing, 119 patients (98%) were asymptomatic and 26 patients (21%) exhibited moderate ischemic ECG modifications which were correlated (P , 0:01) with incomplete revascularization and with the use of GEA to bypass the RCA. A third of patients had moderate ischemic thallium defects on exercise reversible after redistribution (anterior, 10; lateral, 2; inferior, 28). Silent residual myocardial ischemia detected by thallium scintigraphy was correlated (P , 0:001) with ECG modifications and incomplete revascularization; and inferior thallium defects were more frequent when GEA bypassed the RCA (P , 0:05). However, 26% of patients had residual ischemia despite a complete revascularization, and in at least 18% of cases for GEA and 8% for right IMA, arterial graft blood flow was insufficient at maximum exercise level and caused silent residual myocardial ischemia detected by thallium scintigraphy. Conclusions: Myocardial revascularization using bilateral IMAs and GEA offers a satisfactory myocardial perfusion in the majority of cases; however silent residual myocardial ischemia was detected in a third of patients and was related to incomplete revascularization and to insufficient blood flow supply probably due to small diameter of the arterial grafts. q 1999 Elsevier Science B.V. All rights reserved. |
| Databáze: | OpenAIRE |
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