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[Ultrasonography study of the mammary-coronary bypass]
I Zvánovcová1, J Veselka, M Cholt
1Oddĕlení srdecní chirurgie, Klinika zobrazovacích metod FN Motol a 2. LF UK, Praha.
Insights
Ultrasonography can detect mammacoronary bypass graft issues like occlusion or critical stenosis. This imaging technique aids in diagnosing complications after coronary artery bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Diagnostic Imaging
Background:
- Coronary artery bypass grafting (CABG) is a common treatment for ischemic heart disease.
- Left internal mammary artery (LIMA) grafts are frequently used for bypass to the left anterior descending artery (LAD).
Observation:
- A patient with severe angina underwent LIMA to LAD bypass.
- Postoperatively, the patient was asymptomatic, but graft occlusion was suspected via ultrasonography.
- Angiography confirmed occlusion, treated with percutaneous transluminal angioplasty (PTA).
- Recurrent graft stenosis was detected by ultrasonography and confirmed by angiography, necessitating reoperation.
Findings:
- Ultrasonography identified graft occlusion and critical stenosis in a mammacoronary bypass.
- Angiography confirmed the ultrasonographic findings of graft compromise.
- Percutaneous transluminal angioplasty was initially successful but graft stenosis recurred.
Implications:
- Ultrasonographic examination of mammacoronary bypass grafts can be a valuable diagnostic tool.
- Early detection of graft occlusion or stenosis through ultrasonography may improve patient outcomes.
- This highlights the importance of regular graft surveillance after coronary artery bypass surgery.
Abstract:
The authors present the case of a 49-year-old female patient who was admitted with the diagnosis of ischaemic heart disease and the syndrome of angina pectoris grade IV for selective coronarography. For assessment of the affection of one artery, significant stenosis of the insertion of the ramus interventricularis anterior the authors indicated a bypass of the left mammary artery to the ramus interventricularis anterior. During the postoperative course the patient did not have any anginous symptoms or any other clinical signs suggesting ischaemia or necrosis of the heart muscle. During the ultrasonographic check-up examination of the mammarocoronary bypass the suspicion of occlusion of the graft was expressed and this was confirmed on angiography. An angiographically successful percutaneous transluminal angioplasty of occlusion of the bypass was made. During the subsequent ultrasonographic examination the authors suspected again graft occlusion and angiography confirmed a 90% stenosis. Therefore the patient was re-operated. It appears that ultrasonographic examination of the mammacoronary bypass may prove useful in the diagnosis of occlusion or critical stenosis of a graft.