Assessment of Transmural Coronary Blood Flow with Intraoperative Transesophageal Color Doppler Echocardiography During Coronary Revascularization,☆☆

https://doi.org/10.1016/S0894-7317(99)70038-6Get rights and content

Abstract

Intraoperative color Doppler transesophageal echocardiography with a 4- to 7-MHz transducer was performed on 28 consecutive patients who underwent coronary artery bypass grafting to image and evaluate the transmural coronary blood flow before and after cardiopulmonary bypass. The transmural coronary flow was visualized in 26 (92.8%) of 28 patients in the inferior wall and in 13 (46.4%) of 28 patients in the lateral wall. The peak diastolic flow velocity of the transmural coronary artery in the inferior and lateral wall was significantly increased after coronary revascularization in patients with a successful bypass graft to the right coronary artery (from 34.0 ± 19.7 to 64.9 ± 30.9 cm/s, P < .001, n = 10) and to the left circumflex coronary artery (from 35.1 ± 18.6 to 62.1 ± 21.1 cm/s, P < .001, n = 10). No significant changes were observed in patients with no bypass graft to the right or left circumflex coronary artery. Coronary blood flow can be mapped and the velocity measured with Doppler transesophageal echocardiography with a high-frequency (4- to 7-MHz) transducer. Assessment of the transmural coronary flow may provide valuable information and aid in decision making during surgical revascularization. (J Am Soc Echocardiogr 1999;12:241-51.)

Section snippets

Patient Selection

The study included 28 consecutive patients who underwent elective or emergency CABG surgery at Osaka City University Medical School Hospital (Table 1).The study group consisted of 23 men and 5 women, whose ages ranged from 34 to 78 years (mean age 61 ± 12 years). Seven patients had unstable angina, 21 patients were classified as having New York Heart Association class III angina refractory to medical therapy. Nineteen of the 28 patients had a previous Q-wave myocardial infarction. Patients in

RESULTS

The patient characteristics are summarized in Table 1. The saphenous vein bypass graft flows of all patients studied were considered to be appropriate (121.1 ± 39.5 mL/min, range 15 to 210 mL/min). The internal thoracic artery free flow was 95.4 ± 36.2 mL/min. No additional regional wall motion abnormality was observed and no additional revascularization procedure was needed in any patient.

DISCUSSION

The coronary circulation system consists of superficial epicardial coronary arteries, small coronary arteries, arterioles, capillaries, venules, small veins, cardiac veins, coronary sinus, and other structures (Figure 6).6, 7, 8, 9

. Schematic diagram of intramyocardial coronary blood flow. Some veins are related to arteries, and some are independent of arteries. One set of veins has a close relationship to arteries, and the other set is isolated within the muscle fascicle.

Epicardial vessels begin

Acknowledgements

We gratefully acknowledge the assistance of Damian Craig, MS, in the preparation of this manuscript.

References (25)

  • S Minagoe et al.

    Transthoracic Doppler echocardiographic detection of intramyocardial coronary artery flow in humans using high frequency transducer

    J Cardiol

    (1997)
  • MD Abel et al.

    Evaluation of intraoperative transesophageal two-dimensional echocardiography

    Anesthesiology

    (1987)
  • Cited by (6)

    • Transesophageal Doppler Echocardiographic Detection of Intramyocardial Collateral Flow to the Right Coronary Artery and Changes in the Flow to the Inferior Left Ventricular Wall Immediately After Coronary Artery Bypass Grafting

      2006, American Journal of Cardiology
      Citation Excerpt :

      First, we only documented the ability of Doppler TEE to detect collateral flow in the inferior wall, i.e., to the RCA. Current commercially available ultrasound technology does not allow for reliably detecting intramyocardial flow far from the transesophageal probe, i.e., beyond the inferoseptal, inferior, and posterior walls in the transgastric short-axis view.3 One may speculate that the combination of TEE and transthoracic echocardiography would allow for a more inclusive assessment of collateral flow because TEE allows for assessment of intramyocardial flow in the septal, inferior, and posterior walls,3 and TEE allows for it in the septum and apex of the left ventricle.7,8

    • Intraoperative assessment of coronary grafts by novel digital epivascular imaging

      2003, Journal of the American Society of Echocardiography

    Reprint requests: Junichi Yoshikawa, MD, First Department of Internal Medicine, Osaka City University Medical School, 1-5-7 Asahi-Machi, Abeno-Ku, Osaka 545-8586, Japan. E-mail: [email protected].

    ☆☆

    0894-7317/99 $8.00 + 0   27/1/96772

    View full text