Seki T, Kawachi K, Kitamura S
Department of Surgery III, Nara Medical University, Kashihara, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1991 Apr;39(4):393-403.
In adult patients with atherosclerotic coronary artery disease and in pediatric patients with Kawasaki heart disease, characteristics of internal thoracic artery grafts (ITA grafts) used for coronary artery bypass grafting (CABG) were quantitatively assessed by postoperative angiography. In 142 adult patients with a ITA graft for the left anterior descending artery (LAD), the diameter ratio between ITA graft and recipient LAD at the point close to the anastomotic site (ITA/LAD diameter ratio) was determined by postoperative angiography. This ratio for the adult patients as a whole was 1.04 +/- 0.34. The multivariate analysis (Quantification I) was performed to assess the effects of the following 12 factors on the ITA/LAD diameter ratio: (1) age at the time of operation, (2) sex, (3) time-duration from the operation to angiography, (4) laterality of the ITA used, (5) presence of an undivided major side branch of the ITA graft, (6) presence of blood flow competition between the ITA graft and other grafts, (7) presence of distal stenosis of the recipient LAD, (8) severity of LAD stenosis after the operation, and (9-12) presence of hyperlipidemia, diabetes mellitus, hypertension, or smoking history. The standardized category scores of 25% LAD stenosis, 50% LAD stenosis, and blood flow competition between the ITA and other grafts were -0.815, -0.359, and -0.306, respectively. Insignificant stenosis of the recipient coronary artery was associated with reduction of the ITA/LAD diameter ratio, and this ratio strongly correlated with the severity of LAD stenosis (partial correlation coefficient: 0.627). However, no other factors significantly influenced on the ITA/LAD diameter ratio. In 15 pediatric patients, the length and diameter of 19 ITA grafts and 5 saphenous vein grafts (SVGs) which remained patent in the early (about one month) and late (14 +/- 4 months) postoperative period were determined. Only in the ITA graft, increases in graft length and diameter associated with patient growth were recognized. In the present study, the physiological characteristics of the ITA graft were demonstrated as a viable conduit with flow adaptability and growth potential.
在患有动脉粥样硬化性冠状动脉疾病的成年患者以及患有川崎病的儿科患者中，通过术后血管造影对用于冠状动脉旁路移植术（CABG）的胸廓内动脉移植物（ITA移植物）的特征进行了定量评估。在142例接受ITA移植物用于左前降支（LAD）的成年患者中，通过术后血管造影确定了ITA移植物与受体LAD在靠近吻合部位处的直径比（ITA/LAD直径比）。成年患者总体的该比值为1.04±0.34。进行多因素分析（量化I）以评估以下12个因素对ITA/LAD直径比的影响：（1）手术时的年龄，（2）性别，（3）从手术到血管造影的时间间隔，（4）所用ITA的侧别，（5）ITA移植物未分支的主要侧支的存在情况，（6）ITA移植物与其他移植物之间的血流竞争情况，（7）受体LAD远端狭窄的存在情况，（8）术后LAD狭窄的严重程度，以及（9 - 12）高脂血症、糖尿病、高血压或吸烟史的存在情况。LAD狭窄25%、LAD狭窄50%以及ITA与其他移植物之间血流竞争的标准化类别分数分别为 - 0.815、 - 0.359和 - 0.306。受体冠状动脉的轻度狭窄与ITA/LAD直径比的降低相关，并且该比值与LAD狭窄的严重程度密切相关（偏相关系数：0.627）。然而，没有其他因素对ITA/LAD直径比有显著影响。在15例儿科患者中，确定了19个ITA移植物和5个大隐静脉移植物（SVG）在术后早期（约1个月）和晚期（14±4个月）仍保持通畅的长度和直径。仅在ITA移植物中，观察到移植物长度和直径随患者生长而增加。在本研究中，ITA移植物的生理特征表现为具有血流适应性和生长潜力的可行管道。
