Fukaya S, Hayashi I, Lee T
Department of Cardiovascular Surgery, Saitama Eastern Circulation Hospital, Koshigaya, Japan.
Kyobu Geka. 2008 Jul;61(7):554-6.
The gastroepiploic artery (GEA) is available as a graft to the right coronary artery (RCA). However, it is hard to determine an optimal anastomotic site and GEA graft length after upsetting the heart in off-pump coronary artery bypass grafting (OPCAB). To solve these problems, we traced a target coronary tree on the diaphragm and marked an optimal anastomotic site by skin markers. A small incision was made on the diaphragm at the proximal site of the optimal anastomotic position. Appropriate length of GEA graft was determined according to the schema on the diaphragm. By postoperative coronary angiogram performed in 22 cases (25 anastomoses), 22 anastomoses proved patent (88.0%). Flow competition of GEA-4 posterior descending artery (PD) was observed in 2 anastomoses (8.0%). Occlusion of 4PD-4 atrioventricular node artery (AV) sequential portion was observed in 1 anastomosis (4.0%). There was no angulated, redundant or tense graft in any of the patent grafts. This method was suggested to be useful in determining an optimal anastomotic site and GEA graft length.
胃网膜动脉（GEA）可作为移植至右冠状动脉（RCA）的移植物。然而，在非体外循环冠状动脉旁路移植术（OPCAB）中扰乱心脏后，很难确定最佳吻合部位和GEA移植物长度。为了解决这些问题，我们在膈肌上描绘出目标冠状动脉树，并通过皮肤标记物标记出最佳吻合部位。在最佳吻合位置的近端部位在膈肌上做一个小切口。根据膈肌上的示意图确定合适长度的GEA移植物。通过对22例患者（25处吻合）进行术后冠状动脉造影，22处吻合显示通畅（88.0%）。在2处吻合（8.0%）中观察到GEA-4后降支动脉（PD）存在血流竞争。在1处吻合（4.0%）中观察到4PD-4房室结动脉（AV）连续部分闭塞。在任何通畅的移植物中均未发现成角、冗余或紧张的移植物。该方法被认为有助于确定最佳吻合部位和GEA移植物长度。
