Hagiwara H, Shirakawa M, Nakayama T, Asai T, Nakayama M, Ito T, Yano Y
Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
Kyobu Geka. 2005 Jul;58(7):519-23; discussion 524-6.
Recently the availability of transit time flow measurement (TTFM) is reported especially in off-pump coronary artery bypass grafting (CABG). But little is known about TTFM findings in on-pump CABG. We examined the correlation between the TTFM flow pattern and the angiography findings in on-pump CABG. The subjects consisted of 52 patients who underwent on-pump CABG and angiography early after operation. In these patients, 55 internal thoracic artery (ITA), 17 gastroepiploic artery (GEA), 13 saphenous vein graft (SVG) and 41 radial artery (RA) were tested with TTFM during cardiopulmonary bypass (CPB). TTFM demonstrated a diastolic filling pattern in 53 ITA, 16 GEA, 13 SVG and 36 RA. The angiography revealed that all these grafts were perfectly patent with the exception of a GEA with a flow competition pattern. TTFM revealed an abnormal flow pattern in 2 ITA (these 2 grafts were revised during CPB and the angiography demonstrated their perfect patency), 1 GEA (to and fro pattern), 0 SVG and 5 RA (the abnormal pattern was due to graft spasm in 3 of 5, and the angiography revealed their perfect patency, however, the angiography detected stenosis in the remaining 2 grafts). The present study found that the TTFM flow pattern during CPB correlated well with the angiography findings. TTFM during CPB was useful to detect graft failure, and grafts were revised safely during CPB.
最近有报道称可进行渡越时间血流测量（TTFM），尤其是在非体外循环冠状动脉旁路移植术（CABG）中。但对于体外循环CABG中TTFM的发现却知之甚少。我们研究了体外循环CABG中TTFM血流模式与血管造影结果之间的相关性。研究对象包括52例行体外循环CABG并在术后早期进行血管造影的患者。在这些患者中，55支胸廓内动脉（ITA）、17支胃网膜动脉（GEA）、13支大隐静脉移植物（SVG）和41支桡动脉（RA）在体外循环（CPB）期间接受了TTFM检测。TTFM显示53支ITA、16支GEA、13支SVG和36支RA呈舒张期充盈模式。血管造影显示，除1支具有血流竞争模式的GEA外，所有这些移植物均通畅良好。TTFM显示2支ITA血流模式异常（这2支移植物在CPB期间进行了修正，血管造影显示它们通畅良好），1支GEA（往返模式），0支SVG和5支RA血流模式异常（5支中有3支异常模式是由于移植物痉挛，血管造影显示它们通畅良好，然而，血管造影检测到其余2支移植物存在狭窄）。本研究发现，CPB期间的TTFM血流模式与血管造影结果密切相关。CPB期间的TTFM有助于检测移植物功能障碍，并且移植物可在CPB期间安全地进行修正。
