Intraoperative color Doppler ultrasound assessment of LIMA-to-LAD anastomoses in off-pump coronary artery bypass grafting
| Autor: | Arve Tromsdal, Rune Haaverstad, Nicola Vitale, Hans Torp, Stein Samstad, Ole Tjomsland |
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| Rok vydání: | 2002 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Duplex ultrasonography medicine.medical_specialty medicine.medical_treatment Anastomosis Anterior Descending Coronary Artery Intraoperative Period Surgical anastomosis Humans Medicine Coronary Artery Bypass Mammary Arteries Ultrasonography Doppler Color Off-pump coronary artery bypass business.industry Anastomosis Surgical Ultrasound Middle Aged medicine.disease Coronary Vessels Stenosis cardiovascular system Female Surgery Radiology Cardiology and Cardiovascular Medicine business Pericardium Blood Flow Velocity |
| Zdroj: | The Annals of Thoracic Surgery. 74:1390-1394 |
| ISSN: | 0003-4975 |
| Popis: | Background Although techniques for off-pump coronary artery bypass grafting (CABG) are continually being refined, angiographic follow-up studies have indicated a higher rate of anastomoses-related stenoses than expected after traditional on-pump CABG. This study was performed to evaluate the use of intraoperative epicardial color Doppler ultrasound to quality-assess left internal mammary artery (LIMA) to left anterior descending coronary artery (LAD) anastomoses performed on the beating heart. Methods Twenty-four LIMA-to-LAD anastomoses were evaluated with real-time epicardial ultrasound imaging using an ultrasound transducer positioned between the paddles of the stabilizer during off-pump procedures. The length of the anastomosis (D A ), diameters of LIMA (D M ), LAD at the toe of the anastomosis (D 1 ), and 5 mm distally to the anastomosis (D 2 ) were measured, and the ratios between these variables were calculated. The flow velocity through the anastomoses was visualized by color Doppler coding, and flow was assessed with transit-time flowmetry. Results The epicardial color Doppler ultrasound allowed accurate assessment of the anastomoses. Twenty-three (96%) of the primary anastomoses were confirmed as patent. Mean ratios of D 1 /D 2 , D A /D 2 , and D M /D 2 were 0.89 ± 0.13, 3.01 ± 1.04 and 1.32 ± 0.32, respectively. One anastomosis had a stenosis more than 50% detected by color Doppler ultrasound. After surgical revision, transit-time flow increased from 22 to 40 mL/min. Conclusions Intraoperative color Doppler ultrasound allowed adequate imaging for quality assessment of LIMA-to-LAD anastomoses performed on the beating heart. One anastomosis was revised due to a technical error detected by epicardial color Doppler imaging. Epicardial ultrasound scanning is a valuable tool for intraoperative assessment of LIMA-to-LAD anastomoses during off-pump coronary surgery. |
| Databáze: | OpenAIRE |
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