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Published on: November 24, 2014
Is coronary graft doppler more sensitive for individual graft flows than TEE during CABG surgery?
Jean-Francois Morin1, Bergez F Mistry, Lisa Knowlton
1Department of Cardiovascular and Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Canada. imorin@surg.jgh.mcgill.ca
Insights
A normal transesophageal echocardiogram (TEE) did not detect a blocked left internal mammary artery graft. Coronary Doppler ultrasound identified the critical graft issue, enabling timely repair.
Area of Science:
- Cardiovascular Surgery
- Diagnostic Imaging
- Vascular Ultrasound
Background:
- Coronary artery bypass grafting (CABG) is a common surgical procedure.
- The left internal mammary artery (LIMA) is frequently used as a graft to the left anterior descending artery (LAD).
- Postoperative graft assessment is crucial for ensuring graft patency and myocardial perfusion.
Observation:
- A case report details a patient with a patent LIMA-to-LAD graft on immediate postoperative transesophageal echocardiography (TEE).
- Despite a normal TEE, there was a complete absence of flow within the LIMA graft.
- This discrepancy highlighted a potential limitation of TEE in immediate postoperative graft assessment.
Findings:
- Coronary Doppler ultrasound was instrumental in detecting the non-flow state within the LIMA graft.
- The study underscores the utility of Doppler ultrasound in identifying occult graft abnormalities.
- The identified graft occlusion was successfully repaired, restoring flow.
Implications:
- TEE may not always be sufficient for immediate postoperative assessment of LIMA graft patency.
- Coronary Doppler ultrasound should be considered as a complementary or alternative imaging modality.
- Early detection and repair of graft failure can improve patient outcomes after CABG.
Abstract:
In this case report we describe a situation where despite a normal TEE exam immediately postcardiopulmonary bypass, there was no flow in the left internal mammary artery graft to the left anterior descending artery. This was picked up by coronary Doppler and subsequently repaired.
