Abstract
Left internal mammary artery (LIMA) bypass conduits undergo gradual longitudinal flow transition from the proximal to distal segments, and the diastolic/systolic (D/S) ratios of the flow indices can diagnose graft patency. However, the influence of graft adaptation on this has not been studied. We examined 46 patients with LIMA graft to the left anterior descending artery using a Doppler-tipped guidewire in the proximal, middle, and distal segments; 34 had patent LIMAs (group A: new LIMAs; <1 month postoperatively; n = 22 and group B: old LIMAs; ≥1 month postoperatively; n = 12), and 12 had new LIMAs with distal stenosis (group C). In diastole, the time-averaged peak velocities, maximum peak velocities, and velocity–time integrals in each segment were significantly greater in group A than in groups B or C; however, in systole, they did not differ significantly among the three groups. The D/S ratios of the indices in all segments in group A were significantly greater than those in groups B or C; however, they did not differ between groups B and C in any of the segments. Graft adaptation of a patent LIMA, itself, affects the longitudinal flow transition pattern. The D/S ratio of the three indices in the patent old LIMAs did not differ from those in the LIMAs with distal stenosis early after surgery. The timing of LIMA flow assessment must be considered during assessment of the graft patency from the flow velocity patterns.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bach RG, Kern MJ, Donohue TJ, Aguirre FV, Caracciolo EA (1993) Comparison of phasic blood flow velocity characteristics of arterial and venous coronary artery bypass conduits. Circulation 88(5 Pt 2):II133–II140
Gurne O, Chenu P, Polidori C, Louagie Y, Buche M, Haxhe J-P, Eucher P, Marchandise B, Schroeder E (1995) Functional evaluation of internal mammary artery bypass grafts in the early and late postoperative periods. J Am Coll Cardiol 25:1120–1128
Koyama J, Owa M, Asakawa K, Hikita H, Ohkubo K, Ikeda S (1999) Effect of distal stenosis of internal thoracic artery bypass grafts on longitudinal phasic blood flow velocity characteristics. Am Heart J 138:468–476
Akasaka T, Yoshikawa J, Yoshida K, Maeda K, Hozumi T, Nasu M, Shomura T (1995) Flow capacity of internal mammary artery grafts: early restriction and later improvement assessed by Doppler guide wire: comparison with saphenous vein grafts. J Am Coll Cardiol 25:640–647
Katz WE, Zenati M, Mandarino WA, Cohen HA, Gorcsan J III (1999) Assessment of left internal mammary artery graft patency and flow reserve after minimally invasive direct coronary artery bypass. Am J Cardiol 84:795–801
Kern MJ, Bach RG, Donohue TJ, Caracciolo EA, Wolford T, Aguirre FV (1995) Role of large pectoralis branch artery in flow through a patent left internal mammary artery conduit. Cathet Cardiovasc Diagn 34:240–244
Shelton ME, Forman MB, Virmani R, Bajaj A, Stoney WS, Atkinson JB (1988) A comparison of morphologic and angiographic findings in long-term internal mammary artery and saphenous vein bypass grafts. J Am Coll Cardiol 11:297–307
Cameron A, Davis KB, Green GE, Myers WO, Pettinger M (1988) Clinical implications of internal mammary artery bypass grafts: the coronary artery surgery study experience. Circulation 77:815–819
Acinapura AJ, Jacobowitz IJ, Kramer MD, Zisbrod Z, Cunningham JN (1992) Internal mammary artery bypass: thirteen years of experience. Influence of angina and survival in 5125 patients. J Cardiovasc Surg 33:554–559
Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, Golding LA, Gill CC, Taylor PC, Sheldon WC (1986) Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med 314:1–6
Metcalfe MJ, Lip GY, Dargie HJ (1994) Factors influencing coronary artery bypass graft patency. Cardiovasc Surg 2(6):679–685 (review)
Velebit V, Christenson JT, Maurice J, Simonet F, Schmuziger M (1994) A patent internal mammary artery graft decreases the risk of reoperative coronary artery bypass surgery. Tex Heart Inst J 21(2):125–129
He GW, Acuff TE, Ryan WH, Bowman RT, Douthit MB, Mack MJ (1994) Determinants of operative mortality in elderly patients undergoing coronary artery bypass grafting. Emphasis on the influence of internal mammary artery grafting on mortality and morbidity. J Thorac Cardiovasc Surg 108(1):73–81
Grover FL, Johnson RR, Marshall G, Hammermeister KE (1994) Impact of mammary grafts on coronary bypass operative mortality and morbidity. Department of Veterans Affairs Cardiac Surgeons. Ann Thorac Surg 57(3):559–568 (discussion 568–9)
Santarpino G, Onorati F, Scalas C, De Gori M, Cristodoro L, Zofrea S, Renzulli A (2009) Radial artery achieves better flowmetric results than saphenous vein in the elderly. Heart Vessels 24(2):108–115
Mizia-Stec K, Gasior Z, Zahorska-Markiewicz B, Holecki M, Haberka M, Mizia M, Gomulka S, Zak-Golab A, Goscinska A (2008) The indexes of arterial structure and function in women with simple obesity: a preliminary study. Heart Vessels 23(4):224–229
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kumazaki, S., Koyama, J., Aizawa, K. et al. Effect of graft adaptation of the internal mammary artery on longitudinal phasic blood flow velocity characteristics after surgery. Heart Vessels 25, 515–521 (2010). https://doi.org/10.1007/s00380-010-0015-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00380-010-0015-2