Bandyk D F, Galbraith T A, Haasler G B, Almassi G H
Department of Surgery, Medical College of Wisconsin, Milwaukee 53226.
J Surg Res. 1988 Apr;44(4):342-51. doi: 10.1016/0022-4804(88)90176-x.
Doppler-derived blood flow velocity measurements were used to characterize the hemodynamics of 66 internal mammary artery grafts and 60 saphenous vein grafts to the coronary arteries at operation. Pulsed Doppler spectral analysis of centerstream graft flow demonstrated predominantly diastolic flow with a variable, multiphasic flow pattern in systole. The magnitude and configuration of the graft flow velocity waveform varied with graft type and whether the runoff was to single or multiple arteries. At operation, peak diastolic flow velocity was greater (P less than 0.0001) in internal mammary artery grafts to a single outflow artery (71 +/- 2 cm/sec) compared with single vein grafts (31 +/- 4 cm/sec). Sequential grafts demonstrated increased flow velocity and forward flow throughout the pulse cycle, indicative of low outflow resistance. Analysis of the phasic flow patterns permitted an assessment of functional graft patency. Technical errors (anastomotic stricture, internal mammary pedicle torsion) were identified in three grafts with low or absent diastolic flow. Vasospasm of the internal mammary artery was associated with high flow velocity throughout the pulse cycle. Observed differences in patency and the development of intimal hyperplasia between internal mammary artery and saphenous vein grafts may be related to graft hemodynamics.
在手术过程中，使用多普勒衍生的血流速度测量来表征66条乳内动脉移植物和60条大隐静脉移植物至冠状动脉的血流动力学。对移植物中心血流的脉冲多普勒频谱分析显示，主要为舒张期血流，收缩期血流模式多变、呈多相。移植物血流速度波形的大小和形态因移植物类型以及血流是否供应单支或多支动脉而有所不同。手术时，乳内动脉移植物至单支流出动脉的舒张期峰值血流速度（71±2cm/秒）高于单支静脉移植物（31±4cm/秒）（P＜0.0001）。序贯移植物在整个心动周期中显示血流速度增加且向前血流增加，表明流出阻力较低。对血流相模式的分析有助于评估移植物的功能通畅情况。在3条舒张期血流低或无舒张期血流的移植物中发现了技术错误（吻合口狭窄、乳内蒂扭转）。乳内动脉痉挛与整个心动周期中的高血流速度相关。乳内动脉移植物和大隐静脉移植物在通畅情况和内膜增生发展方面观察到的差异可能与移植物血流动力学有关。
