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J Thorac Cardiovasc Surg 1994;108:592-593
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

The right gastroepiploic artery and its growth potential

Tadashi Isomura, MD, Kouichi Hisatomi, MD, Akio Hirano, MD, Kiroku Ohishi, MD, Osamu Inoue, MD, Hirohisa Kato, MD

Second Department of Surgery
Pediatric Department
Kurume University School of Medicine
Fukuoka, Japan

To the Editor:

We congratulate Dr. Suma and his group Go 1 for their superb work on the midterm patency of the right gastroepiploic artery (GEA).

We have restudied a right GEA that was used to revascularize a coronary artery in an 8-year-old boy. Go 2 We recently performed an angiogram 45 months after the operation and compared the films with those obtained 1 month after the operation. As seen in Fig. 1, both the internal thoracic artery (ITA) and the GEA seemed to show similar growth potential. Kitamura and associates Go 3 reported that the ITA graft has the potential to grow in children. Our patient gained more than 16 kg after the operation. We measured the proximal and distal diameters of the graft by angiography and found that the diameter of the proximal GEA (Fig. 1, large arrowhead) had grown from 3.2 to 4.2 mm and that of the distal site (Fig. 1, small arrowhead) had increased from 1.3 to 2.4 mm as compared with the angiogram taken 1 month after the operation. The results seemed to be in accord with the growth potential reported by Kitamura's group Go 3 for the ITA in children in 1988.




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  		Fig. 1. Angiogram taken 45 months after operation (the size of catheter is 6F). Both the left ITA and right GEA are patent, and the left anterior descending branch (LAD)and posterior descending branch (PD)are clearly demonstrated by the flows through the arterial grafts. Growth of the GEA is evident by measuring the proximal (large arrowhead)and distal (small arrowhead) diameters and comparing them with those seen in the angiogram taken 1 month after the operation (Fig. 2 in reference 2).

 
We have been using the GEA in selected patients Go 4 and have performed 70 bypass grafts with the GEA in the past 5 years. No additional angioplasty or reoperation was required in those patients. Five patients have had a second angiogram between 1 and 4 years after the operation, and all showed patent GEA grafts, as in Suma's report. Go 1 We agree with Suma's results and consider the GEA to be a viable alternative to the ITA with regard to patency.

References

  1. Suma H, Wanibuchi Y, Terada Y, Fukuda S, Takayama T, Furuta S. The right gastroepiploic artery graft: clinical and angiographic midterm results in 200 patients. J THORAC CARDIOVASC SURG 1993;105:615-23.[Abstract]
  2. Isomura T, Hisatomi K, Asoh S, et al. Revascularization with the right gastroepiploic artery in Kawasaki's disease [Letter]. J THORAC CARDIOVASC SURG 1990;100:796-8.[Medline]
  3. Kitamura S, Seki T, Kawachi K, et al. Excellent patency and growth potential of internal mammary artery grafts in pediatric coronary artery bypass surgery: new evidence for a"live" conduit. Circulation 1988;78(suppl):I129-39.
  4. Isomura T, Hisatomi K, Hirano A, Hayashida N, Ohishi K. Use of the right gastroepiploic artery as a pedicled arterial graft for coronary revascularization. Eur J Cardiothorac Surg 1993;7:38-41.[Abstract]



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T. Isomura, T. Sato, K. Hisatomi, N. Hayashida, and H. Maruyama
Intermediate Clinical Results of Combined Gastroepiploic and Internal Thoracic Artery Bypass
Ann. Thorac. Surg., December 1, 1996; 62(6): 1743 - 1747.
[Abstract] [Full Text]

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