Kawachi K, Kitamura S, Seki T, Morita R, Kawata T, Hasegawa J, Kameda Y
Department of Surgery III, Nara Medical College, Japan.
Circulation. 1991 Aug;84(2):618-24. doi: 10.1161/01.cir.84.2.618.
Saphenous vein grafts (SVG) and internal mammary artery (IMA) grafts have been used for coronary artery bypass grafting. In adult patients with bypass grafting for atherosclerotic coronary artery disease, IMA grafts have been reported to have long-term patency; however, results are conflicting on whether the graft is sufficient to meet increased myocardial oxygen demand during exercise. There have been no studies on hemodynamics and blood flow during exercise after bypass grafting with IMA in pediatric patients with Kawasaki disease.
We studied 17 pediatric patients with Kawasaki disease (average age, 7.5 +/- 3.1 years), who underwent coronary artery bypass grafting with the IMA. The average number of coronary artery bypass grafts was 2.1 +/- 0.7/patient. For all patients, the left IMA was anastomosed to the left anterior descending coronary artery; for eight patients, the right IMA was also anastomosed to the right coronary artery. In addition, 11 SVGs were used. The postoperative patency rates after 1 month were 100% with the IMA graft and 91% with SVG. One year after the operation, the patency rates were 100% with IMA and 50% with SVG. Hemodynamics during exercise were measured with a bicycle ergometer, and coronary sinus blood flow was measured by the continuous thermodilution method in six patients. The relation between delta LVEDP (the difference between left ventricular end-diastolic pressure at rest and during exercise) and delta SVI (the difference between the stroke volume index at rest and during exercise) was analyzed. Four of six patients had reduced cardiac function before operation (delta LVEDP, positive; delta SVI, negative). However, after the operation, all patients demonstrated improvements in cardiac function during exercise (delta LVEDP, positive; delta SVI, positive). Coronary sinus flow per left ventricular mass increased after operation from 70 +/- 46 to 87 +/- 56 ml/min at rest (p less than 0.05) and from 139 +/- 118 to 183 +/- 150 ml/min during exercise (p less than 0.05).
In conclusion, this study reveals improvements in both hemodynamics and coronary blood flow during exercise after coronary artery bypass grafting with IMA grafts in pediatric patients with Kawasaki disease.
大隐静脉移植物（SVG）和乳内动脉（IMA）移植物已用于冠状动脉旁路移植术。在因动脉粥样硬化性冠状动脉疾病接受旁路移植术的成年患者中，据报道IMA移植物具有长期通畅性；然而，关于该移植物是否足以满足运动期间增加的心肌需氧量，结果存在矛盾。对于患有川崎病的儿科患者，在IMA旁路移植术后运动期间的血流动力学和血流量尚无研究。
我们研究了17例接受IMA冠状动脉旁路移植术的川崎病儿科患者（平均年龄7.5±3.1岁）。每位患者冠状动脉旁路移植的平均数量为2.1±0.7。所有患者中，左IMA均吻合至左冠状动脉前降支；8例患者的右IMA还吻合至右冠状动脉。此外，使用了11条SVG。IMA移植物术后1个月的通畅率为100%，SVG为91%。术后1年，IMA的通畅率为100%，SVG为50%。6例患者通过自行车测力计测量运动期间的血流动力学，并采用连续热稀释法测量冠状窦血流量。分析了左心室舒张末期压力差值（静息时与运动时左心室舒张末期压力之差）与每搏量指数差值（静息时与运动时每搏量指数之差）之间的关系。6例患者中有4例术前心功能降低（左心室舒张末期压力差值为正值；每搏量指数差值为负值）。然而，术后所有患者运动期间的心功能均有改善（左心室舒张末期压力差值为正值；每搏量指数差值为正值）。静息时每左心室质量的冠状窦血流量术后从70±46增加至87±56 ml/min（p<0.05），运动时从139±118增加至183±150 ml/min（p<0.05）。
总之，本研究揭示了患有川崎病的儿科患者在IMA移植物冠状动脉旁路移植术后运动期间血流动力学和冠状动脉血流量均有改善。
