非体外循环冠状动脉搭桥手术中，术中彩色多普勒超声对左乳内动脉与左前降支冠状动脉吻合情况的评估与8个月随访时的血管造影评估相关。

Intraoperative color Doppler ultrasound assessment of anastomoses of the left internal mammary artery to the left anterior descending coronary artery during off-pump coronary artery bypass surgery correlates with angiographic evaluation at the 8-month follow-up.

作者信息

Tjomsland Ole, Wiseth Rune, Wahba Alexander, Tromsdal Arve, Samstad Stein O, Haaverstad Rune

机构信息

St. Elisabeth Heart Center and Institute of Circulation and Imaging Techniques, Norwegian University of Science and Technology, Trondheim, Norway.

出版信息

Heart Surg Forum. 2003;6(5):375-9.

PMID:14721813

Abstract

OBJECTIVE

This study was performed to evaluate the correlation between intraoperative color Doppler ultrasound assessment of anastomoses of the left internal mammary artery (LIMA) to the left anterior descending coronary artery (LAD) performed on the beating heart and the angiographic assessment after 8 months.

METHODS

Twenty patients (M/F ratio, 14:6; mean age, 62 +/- 8 years) underwent epicardial color Doppler ultrasound imaging with a 10-MHz linear array GE Vingmed transducer combined with a GE Vingmed System FiVe. Transit-time flowmetry was used as intraoperative control. Follow-up coronary angiography after a median of 245 days (range, 128-320 days) allowed assessment of thrombolysis in myocardial infarction (TIMI) flow and FitzGibbon grading in all patients. Detailed quantitative coronary angiography was performed in 10 patients with an emphasis on comparing the LAD diameter at the toe of the anastomosis (D1) and in the downstream LAD (D2).

RESULTS

Intraoperative ultrasound analysis revealed 19 patent LIMA-LAD anastomoses (95%). A >50% stenosis was detected in 1 anastomosis (5%), which was subsequently revised successfully. Follow-up angiographic evaluation showed TIMI-III flow and FitzGibbon grade A in 18 of 20 anastomoses (90%). One anastomosis was occluded, and one had FitzGibbon grade B stenosis. The D1/D2 ratios of the LAD measurements assessed with intraoperative ultrasound and follow-up quantitative coronary angiography were significantly correlated (r2 = 0.62; P < .01).

CONCLUSION

Intraoperative color Doppler ultrasound allows a detailed evaluation of LIMA-LAD anastomoses during off-pump surgery, and the results correlate significantly with those of angiographic evaluation after 8 months. The present study shows that epicardial ultrasound is a promising tool for verification of LIMA-LAD anastomoses performed on the beating heart and may reduce the risk of impaired graft flow caused by technical errors.

摘要

目的

本研究旨在评估在跳动心脏上对左乳内动脉（LIMA）至左前降支冠状动脉（LAD）吻合口进行术中彩色多普勒超声评估与8个月后血管造影评估之间的相关性。

方法

20例患者（男/女比例为14:6；平均年龄62±8岁）使用10MHz线性阵列GE Vingmed探头结合GE Vingmed System FiVe进行心外膜彩色多普勒超声成像。使用渡越时间血流仪作为术中对照。在中位245天（范围128 - 320天）后进行随访冠状动脉造影，以评估所有患者的心肌梗死溶栓（TIMI）血流和菲茨吉本分级。对10例患者进行了详细的定量冠状动脉造影，重点比较吻合口趾部LAD直径（D1）和LAD下游（D2）的直径。

结果

术中超声分析显示19例LIMA - LAD吻合口通畅（95%）。在1例吻合口中检测到>50%的狭窄（5%），随后成功进行了修复。随访血管造影评估显示20例吻合口中18例（90%）为TIMI - III级血流和菲茨吉本A级。1例吻合口闭塞,1例有菲茨吉本B级狭窄。术中超声和随访定量冠状动脉造影评估的LAD测量值的D1/D2比值显著相关（r2 = 0.62；P < 0.01）。