Intraoperative monitoring of IMA flow: what does it mean?

BACKGROUND

This study examines whether the measurement of internal thoracic artery (ITA) graft flow can determine the adequacy of the ITA-left anterior descending coronary artery (LAD) anastomosis.

METHODS

To study a wide range of clinical problems, we used a computer simulation of the cardiovascular system. The model included a time-varying elastance model of the heart, a systemic circulation represented by a multielement nonlinear model of the aorta and its major branches, a nonlinear model of the LAD circulation, and a model of the ITA bypass graft.

RESULTS

With a mild LAD stenosis, ITA graft flow was low and flow reversal occurred. As the percent stenosis increased, ITA flow and the percentage of ITA-to-total LAD flow increased. The ITA graft helped to maintain resting LAD blood flow. A partial obstruction (40%) at the ITA-LAD anastomosis reduced ITA graft flow at similar levels of LAD stenosis. However, overlap in flow values comparing a normal with a partially obstructed anastomosis occurred.

CONCLUSIONS

Flow patterns in the ITA are highly dependent on the degree of stenosis of the LAD as well as the integrity of the anastomosis. The predictive power of ITA flow measurement increases with severe stenosis or total occlusion of the proximal LAD and with high coronary blood flow demands.