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The hemodynamic characteristics and differences after the internal mammary artery-circumflex artery anastomosis and the aorta-circumflex artery bypass graft were evaluated in dogs to determine the indication of these two procedures for clinical application. As a graft, the femora l artery, femoral vein or the cephalic vein was utilized. In acute experiments, compared to the normal circumflex artery, there were no differences in flow rate and reactive hyperemia between these two procedures. But flow pattern of the internal mammary artery anastomosis was characteristic. In early systolic period the flow increased to the maxima l level and decreased in relatively early pericd of diastole. In chronic experiments, resting flow rate was almost comparable with the normal circumflex flow, but reactive hyperemic augmentation was not sufficient. This may be due to scar formation surrounding the vessels or their intimal thickening. Flow pattern of the intern al mammary artery anastomosed to the circumflex artery changed from the immediate postoperative pattern to that resembling that of the normal circumflex artery. Histological examination r evealed a little thicker intimal proliferation in the vein graft than in the internal mammary artery or artery graft. Presently, the method of the two procedures in which the diameter of the vessel matches the coronary artery proposed the anastomosis, should be utilized in the clinical cases. Two clinical cases where the right coronary artery was bypassed from the aorta by a saphenous vein graft are reported.

nagoya journal of medical science

A study of direct coronary surgery. Flow studies of the internal mammary artery-circumflex artery anastomosis and the aorto-circumflex artery bypass graft, and a report of two clinical cases.