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J Thorac Cardiovasc Surg 1996;112:52-58
© 1996 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

CHANGING FLOW PATTERN OF THE INTERNAL THORACIC ARTERY UNDERGOING CORONARY BYPASS GRAFTING: CONTINUOUS-WAVE DOPPLER ASSESSMENT

From the Division of Cardiovascular Surgery, Department of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.

Received for publication April 10, 1995 Accepted for publication August 28, 1995. Address for reprints: Raymond Cartier, MD, Montreal Heart Institute, 5000 Belanger St., Montreal, Quebec H1T 1C8, Canada.

Abstract

Surgeons have limited ability to evaluate intraoperatively the patency of internal thoracic artery graft as a bypass for coronary artery revascularization. We used continuous-wave Doppler ultrasonography to study the velocity of the internal thoracic artery before harvesting and after grafting (scanning probe, 8 MHz). Systolic and diastolic frequency shift (in kilohertz) and systolic frequency/diastolic frequency index were analyzed. Twenty four internal thoracic artery grafts in 15 patients were studied. Fourteen internal thoracic artery grafts were anastomosed to the left anterior descending artery, one to a diagonal artery, and nine to the circumflex artery. The mean systolic frequency before harvesting was 1.19 ± 0.40 KHz and no significant differences were found between the right and the left internal thoracic artery (right, 1.17 ± 0.37; left, 1.19 ± 0.42 KHz). There was a 40% drop in systolic frequency related to the harvesting. Mean systolic frequency decreased after grafting (1.19 ± 0.40 versus 0.87 ± 0.32 KHz; p < 0.01) whereas mean diastolic frequency doubled (0.32 ± 0.12 versus 0.83 ± 0.4 KHz; p < 0.001) and mean diastolic frequency/systolic frequency index increased from 28% ± 11% to 101% ± 39% (p < 0.001), indicating an increased myocardial vascularization during diastole. No significant difference was found between grafted arteries (left anterior descending versus circumflex). All patients had an uneventful postoperative course and no perioperative myocardial infarction was reported. Doppler flow quantification of internal thoracic artery bypasses may give the surgeon an opportunity to evaluate intraoperatively the physiologic features and patency of the internal thoracic artery before and after coronary artery bypasses. (J THORACCARDIOVASCSURG1996;112:52-8)

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