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Non-invasive Doppler technique for detection of flow velocity in left internal mammary artery grafts
1Department of Thoracic and Cardiovascular Surgery, Kobe City General Hospital, Japan.
Insights
Doppler ultrasound effectively assesses left internal mammary artery graft patency. Diastolic flow patterns reliably differentiate between patent and stenotic grafts, aiding clinical decisions.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Vascular Ultrasound
Background:
- Left internal mammary artery (LIMA) grafts are crucial for coronary artery bypass grafting (CABG).
- Assessing LIMA graft patency post-CABG is vital for patient outcomes.
- Non-invasive Doppler ultrasound offers a potential method for evaluating graft status.
Purpose of the Study:
- To evaluate the efficacy of Doppler ultrasound in detecting the patency of LIMA grafts using a supraclavicular approach.
- To correlate Doppler-derived flow velocity patterns with angiographic findings of LIMA graft stenosis.
Main Methods:
- 37 patients with LIMA-to-left anterior descending artery grafts were studied.
- Patients were grouped based on postoperative coronary angiography: Group 1 (no LIMA stenosis, LAD obstruction), Group 2 (no LIMA stenosis, 75% LAD stenosis), Group 3 (significant LIMA stenosis).
- Doppler analysis included systolic peak velocity (SPV), diastolic peak velocity (DPV), time velocity integrals, and velocity ratios.
Main Results:
- No significant differences in SPV and systolic time velocity integral (SI) were observed across groups.
- DPV and diastolic time velocity integral (DI) were significantly higher in Group 1 compared to Groups 2 and 3.
- Ratios of DPV/SPV and DI/(DI+SI) were significantly lower in Group 3 (stenotic grafts) than in Groups 1 and 2.
Conclusions:
- Doppler ultrasound, particularly analysis of diastolic flow parameters, can effectively detect LIMA graft stenosis.
- Diastolic velocity patterns are sensitive indicators of graft patency and function.
- The supraclavicular approach for Doppler assessment of LIMA grafts is feasible and informative.
Abstract:
The capability of Doppler to detect patency of left internal mammary artery grafts through the supraclavicular approach was evaluated. A total of 37 patients with a left internal mammary artery graft to the left anterior descending artery were divided into three groups, according to postoperative coronary angiographic studies. Group 1 comprised 20 patients with no significant stenosis of the left internal mammary artery and subtotal or total obstruction in the left anterior descending coronary artery proximal to the anastomotic site. There were ten patients with no significant stenosis of the left internal mammary artery and 75% stenosis of the left anterior descending coronary artery in group 2. Seven patients with significant stenosis of the left internal mammary artery formed group 3. Analysis of the flow velocity pattern in the left internal mammary artery graft included: (1) systolic peak velocity (SPV), (2) diastolic peak velocity (DPV), (3) systolic time velocity integral (SI), (4) diastolic time velocity integral (DI), (5) diastolic peak velocity/systolic peak velocity and (6) diastolic time velocity integral/diastolic time velocity integral+systolic time velocity integral. There were no significant differences in systolic peak velocity and systolic time velocity integral between the three groups. The diastolic peak velocity and diastolic time velocity integral were greater in group 1 than in groups 2 (P < 0.05, P < 0.01) and 3 (P < 0.05). The diastolic peak velocity/systolic peak velocity and diastolic time velocity integral/diastolic time velocity integral+systolic time velocity integral ratios in group 3 were significantly smaller than in groups 1 and 2 (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)