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Preoperative evaluation of the right internal thoracic artery for coronary surgery
1Section of Cardiothoracic Surgery, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Insights
The right internal thoracic artery (ITA) is as suitable for coronary artery bypass grafting as the left ITA. Noninvasive ultrasound showed no significant anatomic or hemodynamic differences between the right and left ITA in 171 patients.
Area of Science:
- Cardiovascular Surgery
- Vascular Imaging
- Anatomy
Background:
- The left internal thoracic artery (ITA) is more frequently used than the right ITA in coronary artery bypass grafting.
- The reasons for the underuse of the right ITA are not fully understood.
- Preoperative assessment of ITA suitability is crucial for successful bypass procedures.
Purpose of the Study:
- To investigate potential anatomic or hemodynamic reasons for the underuse of the right ITA.
- To compare the morphologic and functional characteristics of the right and left ITAs.
- To evaluate the utility of color-flow duplex ultrasound for preoperative assessment of the right ITA.
Main Methods:
- Noninvasive measurements of right and left ITAs were performed in 171 patients prior to coronary artery bypass grafting.
- Color-flow duplex ultrasound imaging with a 5.0-MHz probe was used for transthoracic visualization.
- Vessel diameter, peak systolic velocity, and end-diastolic velocity were measured for both ITAs.
Main Results:
- No statistically significant differences were found in diameter, peak systolic velocity, or end-diastolic velocity between the right and left ITAs.
- Measurements were consistent across different age groups and sexes, and in patients with or without hypertension or diabetes mellitus.
- Color-flow duplex ultrasound proved to be a safe and reliable method for assessing ITA characteristics.
Conclusions:
- There are no significant morphologic or physiologic differences between the right and left internal thoracic arteries.
- The underuse of the right ITA in coronary artery bypass grafting may not be due to inherent vessel characteristics.
- Color-flow duplex ultrasound is a valuable tool for preoperative evaluation of the right ITA, supporting its potential use as a graft.
Abstract:
In general, the right internal thoracic artery (ITA) is used less frequently as a graft than the left ITA in coronary artery bypass grafting. To determine whether there is an anatomic or hemodynamic rationale for the underuse of the right ITA, noninvasive measurements of right and left ITAs were performed in 171 patients before the bypass procedure. Transthoracic visualization of both vessels was accomplished using a color-flow duplex scanner (5.0-MHz probe) through the third intercostal space. The diameter (in millimeters), peak systolic velocity (in centimeters per second), and end-diastolic velocity (in centimeters per second) were measured in all but 2 patients. The mean right ITA diameter was 2.7 +/- 0.6 mm, the mean peak systolic velocity was 100 +/- 29 cm/s, and the mean end-diastolic velocity was 6 +/- 5 cm/s. Diameter and flow velocity measurements for the right and left ITA were similar in all patients (p = not significant). The measured values for both sites were independent of age and sex, or the presence of hypertension or diabetes mellitus (p = not significant). We conclude that no morphologic or physiologic differences exist between the right and left ITAs. The findings from this study indicate that color-flow duplex ultrasound imaging is a safe and reliable noninvasive technique in the preoperative assessment of the anatomic and functional characteristics of the right ITA before coronary artery bypass grafting.