Open AccessAssessment of Left Internal Mammary Artery Graft Patency by Transthoracic Doppler Echocardiography
Author(s) -
ElMasry Magdy M.,
Salama Mai M.,
Darwish Ahmed Z.,
ElAziz Osama Abd
Publication year - 2002
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960251107
Subject(s) - medicine , cardiology , doppler echocardiography , mammary artery , doppler effect , gauche effect , radiology , artery , diastole , blood pressure , physics , astronomy
Background : The successful application of noninvasive Doppler spectrum analysis has been reported for the hemodynamic assessment of LIMA graft after myocardial revascularization. Hypothesis : The objective of this study was to assess the utility of transthoracic Doppler echocardiography (TTE) in providing information on LIMA flow in patients after coronary artery bypass graft surgery. Methods : In all, 22 patients (aged 62 ± 8 years) with LIMA graft to the left anterior descending (LAD) coronary artery who underwent coronary angiography were assessed using high‐frequency (5 MHz) transthoracic Doppler echocardiography. They were compared with 25 patients with angina (control group A, aged 59 ± 12 years), in whom an ungrafted LIMA was assessed, and with 17 patients (control group B, aged 59 ± 9 years) with angiographically normal coronary arteries, in whom the LAD was assessed. Results : A biphasic pattern (systolic and diastolic) was recorded in all cases. In 14 patients with a normal graft or < 70% stenosis (Group 1) and in control group B, blood flow was maximal during diastole. In eight patients with severe graft stenosis >70% (Group 2) and control group B, blood flow was maximal during systole, with low diastolic flow. The diastolic fraction of the velocity time integrals was 0.81 ± 0.11 for Group 1 and 0.25 ± 0.06 for Group 2 (p < 0.05). A diastolic velocity time integral fraction < 0.5 predicted gt; 70% stenosis with a sensitivity and specificity of 100%. The ratio of systolic/diastolic peak velocities was 0.61 ± 0.31 for Group 1 and 3.21 ± 0.49 for Group 2 (p<0.05). A systolic/diastolic peak velocity gt; 1 predicted stenosis >70% with a sensitivity and specificity of 100 and 90%, respectively. Conclusions : High‐frequency TTE is a useful noninvasive method for detecting LIMA graft blood flow. Severe graft stenoses exhibited Doppler velocity patterns, which were different from those of patent grafts, or grafts with moderate stenoses.