Boehm D H, Wintersperger B J, Reichenspurner H, Gulbins H, Detter C, Kur F, Meiser B, Reichart B
Department of Cardiac Surgery, Diagnostic Radiology, University of Munich, Klinikum Grosshadern, Munich, Germany.
Heart Surg Forum. 1999;2(3):222-5.
The purpose of this study was to delineate the course and determine the patency of venous and arterial conduits in the early postoperative period following minimally invasive bypass grafting. A less invasive magnetic resonance angiogram was evaluated as alternative to standard contrast angiography and cardiac catheterization.
Twelve patients (8 males and 4 females) with a mean age of 65.3 (+/- 7.4 ) years were evaluated four to seven days following minimally invasive direct coronary artery bypass surgery (MIDCAB) or off-pump multivessel revascularization with the Octopus stabilizer on the beating heart. Altogether 17 coronary bypass grafts were investigated: 12 left-sided mammary artery grafts to the LAD and five aortocoronary venous bypass grafts. The examination was performed with a 1.5 Tesla Magnetom Vision (Siemens AG, Erlangen) with phased array coil technology. Data acquisition was done with an ultrafast 3D gradient-echosequence in single breathhold and sagittal and coronal views. Contrast enhancement of the vessels was performed with automatic intravenous bolus injection of Gadolinium-DTPA after determination of the individual contrast transit time. Traditional contrast angiography was obtained in all patients during the same time period as a comparison to assess the sensitivity and specificity of the magnetic resonance imaging.
All five venous grafts and 11 of the 12 IMA grafts were detected and shown to be patent with the MRA technique. Contrast angiography demonstrated complete patency for all 17 bypass grafts with adequate anastomoses and no evidence of stenosis. The calculated sensitivity for the visualization with MRA was therefore 92% for IMA grafts and 100% for venous grafts.
The contrast-enhanced ultrafast MRA in single breathhold technique is a reliable, noninvasive method for visualization and determination of the patency of arterial and venous coronary grafts.
本研究旨在描绘微创搭桥术后早期静脉和动脉血管的走行并确定其通畅情况。评估一种侵入性较小的磁共振血管造影术作为标准造影血管造影和心导管检查的替代方法。
对12例患者（8例男性，4例女性）进行评估，平均年龄65.3（±7.4）岁，这些患者在微创直接冠状动脉搭桥手术（MIDCAB）或使用章鱼稳定器在跳动心脏上进行非体外循环多支血管血运重建术后四至七天接受检查。共研究了17条冠状动脉搭桥血管：12条左侧乳内动脉至左前降支的血管以及5条主动脉冠状动脉静脉搭桥血管。检查使用1.5特斯拉Magnetom Vision（西门子公司，埃尔朗根）及相控阵线圈技术进行。数据采集采用单次屏气的超快三维梯度回波序列，在矢状面和冠状面视图下进行。在确定个体造影剂通过时间后，通过自动静脉团注钆喷酸葡胺对血管进行造影增强。在同一时期对所有患者进行传统造影血管造影作为对照，以评估磁共振成像的敏感性和特异性。
通过磁共振血管造影术检测到所有5条静脉血管和12条乳内动脉血管中的11条，显示通畅。造影血管造影显示所有17条搭桥血管完全通畅，吻合良好，无狭窄迹象。因此，计算得出磁共振血管造影术对乳内动脉血管显影的敏感性为92%，对静脉血管显影的敏感性为100%。
单次屏气技术的造影增强超快磁共振血管造影术是一种可靠的、非侵入性的方法，可用于观察和确定冠状动脉动静脉搭桥血管的通畅情况。
