Singh R N, Sosa J A
J Thorac Cardiovasc Surg. 1981 Dec;82(6):909-14.
Five of 20 (25%) symptomatic patients with internal mammary artery (IMA) grafts were found to have unusually enlarged side branches on arteriographic studies. One had a large lateral costal branch and four had large pericardial branches with collaterals draining into the pulmonary circulation. In these patients there was significant reduction (mean 44% +/- 3%) in the lumen of the distal IMA compared to its proximal part, with poor filling of the grafted coronary artery. This appeared to be the only cause of anginal symptoms in three of these five patients. The other 15 patients (75%) with small or no side branches had little or no reduction (mean 10% +/- 2%) of the distal IMA lumen. There was good coronary filling in these cases. The enlargement of the side branches indicates large flow in these branches with consequent reduction of flow in the grafted coronary artery. The marked reduction of the distal IMA lumen is a useful sign of reduced graft flow. This phenomenon may be one of the causes of poor results following IMA grafting.
20例有症状的采用乳内动脉（IMA）移植的患者中，25%（5例）在动脉造影研究中发现其侧支异常增粗。1例有粗大的外侧肋支，4例有粗大的心包支并有侧支引流至肺循环。与IMA近端相比，这些患者IMA远端管腔显著减小（平均44%±3%），移植的冠状动脉充盈不佳。这似乎是这5例患者中3例心绞痛症状的唯一原因。另外15例（75%）侧支细小或无侧支的患者，IMA远端管腔几乎没有减小（平均10%±2%）。这些病例中冠状动脉充盈良好。侧支增粗表明这些分支血流较大，从而导致移植的冠状动脉血流减少。IMA远端管腔显著减小是移植血流减少的一个有用征象。这种现象可能是IMA移植后效果不佳的原因之一。
