Assessment of Transmural Coronary Blood Flow with Intraoperative Transesophageal Color Doppler Echocardiography During Coronary Revascularization☆,☆☆
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, 9Epicardial vessels begin
Acknowledgements
We gratefully acknowledge the assistance of Damian Craig, MS, in the preparation of this manuscript.
References (25)
- et al.
Immediate improvement of dysfunctional myocardial segments after coronary revascularization: detection by intraoperative transesophageal echocardiography
J Am Coll Cardiol
(1984) - et al.
The reversal of flow in the cardiac veins
Am Heart J
(1930) - et al.
The nature of the vascular communications between the coronary arteries and the chambers of the heart
Am Heart J
(1933) - et al.
The vascular supply of the left ventricular wall: anatomic observations, plus a hypothesis regarding acute events in coronary artery disease
Am Heart J
(1966) - et al.
Operative flow measurements and coronary bypass graft patency
J Thorac Cardiovasc Surg
(1976) - et al.
Anatomic-ultrasound correlations for intraoperative open chest imaging of coronary artery atherosclerotic lesions in human beings
J Am Coll Cardiol
(1984) - et al.
High frequency epicardial echocardiography for coronary artery evaluation: in vitro and in vivo validation of arterial lumen and wall thickness measurements
J Am Coll Cardiol
(1986) - et al.
Intraoperative cardioplegic contrast echocardiography for assessing myocardial perfusion during open heart surgery
J Am Coll Cardiol
(1984) - et al.
Assessment of regional and transmural myocardial perfusion by means of intraoperative myocardial contrast echocardiography during coronary artery bypass grafting
J Thorac Cardiovasc Surg
(1992) - et al.
Intraoperative assessment of regional myocardial perfusion using quantitative myocardial contrast echocardiography: an experimental evaluation
J Am Coll Cardiol
(1990)
Transthoracic Doppler echocardiographic detection of intramyocardial coronary artery flow in humans using high frequency transducer
J Cardiol
Evaluation of intraoperative transesophageal two-dimensional echocardiography
Anesthesiology
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 CardiologyCitation 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 EchocardiographyTransesophageal echocardiography (TEE) in the evaluation of the coronary arteries
2000, Cardiology ClinicsTransesophageal echocardiographic evaluation of coronary arteries for stenosis in the elderly patient
2001, American Journal of Geriatric Cardiology
- ☆
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