Voci P, Plaustro G, Testa G, Marino B, Campa P P
II Cattedra di Cardiologia, Università degli Studi La Sapienza, Roma.
Cardiologia. 1998 Apr;43(4):403-6.
The internal mammary artery is routinely used for coronary artery bypass grafting because of its optimal long-term patency profile. This vessel can be imaged by angiography, but only the proximal tract at the origin from the succlavian artery can be imaged by conventional echography. The aim of our study was to visualize the intrathoracic course of the native and grafted internal mammary arteries by a new ultrasound equipment which allows high-resolution transthoracic color Doppler imaging of the chest wall vessels and coronary arteries. We studied 35 patients, 16 non operated and 19 operated of coronary surgery with the internal mammary artery grafted to the left anterior descending coronary artery. We used a multifrequency 3.5-7 MHz transducer with a small insonating surface, placed at the second-fifth intercostal space at the left and right sternal border, to image the native mammary arteries. The grafted mammary artery was detected at the fourth-fifth left intercostal space 2-4 cm lateral to the sternal border. The native left internal mammary artery was visualized in all 16 non operated patients, and the right internal mammary artery in 14/16 (87%). The native left internal mammary artery peak flow velocity was 41-160 cm/s (mean 81 +/- 34 cm/s), and the mean flow velocity was 28-89 cm/s (mean 45 +/- 17 cm/s). The right internal mammary artery peak flow velocity was 35-153 cm/s (mean 82 +/- 36 cm/s), and mean flow velocity was 21-82 cm/s (mean 46 +/- 22 cm/s). The grafted left internal mammary artery was visualized in 16/19 patients (84%), evaluated at 6 days to 36 months after surgery. Peak diastolic flow velocity ranged from 24 to 80 cm/s (mean 48 +/- 17 cm/s), and mean diastolic flow velocity ranged from 13 to 57 cm/s (mean 33 +/- 11 cm/s). The left anterior descending peak flow velocity distal to the anastomosis was 22-62 cm/s (mean 37 +/- 15 cm/s) and mean flow velocity was 18-53 cm/s (mean 29 +/- 12 cm/s). We conclude that transthoracic color Doppler echocardiography allows to image the native and grafted mammary arteries, with potential clinical applications in the management of patients with coronary artery disease.
由于乳内动脉具有最佳的长期通畅性，因此在冠状动脉旁路移植术中经常被使用。该血管可通过血管造影成像，但传统超声检查仅能显示其在锁骨下动脉起始处的近端部分。本研究的目的是使用一种新型超声设备来显示天然和移植乳内动脉在胸腔内的走行，该设备能够对胸壁血管和冠状动脉进行高分辨率经胸彩色多普勒成像。我们研究了35例患者，其中16例未接受手术，19例接受了冠状动脉手术，将乳内动脉移植到左前降支冠状动脉。我们使用一个具有小超声探头表面的多频率3.5 - 7MHz探头，放置在左右胸骨旁第2 - 5肋间，以显示天然乳内动脉。在胸骨旁左侧第4 - 5肋间、距胸骨边缘外侧2 - 4cm处检测到移植的乳内动脉。在所有16例未接受手术的患者中均显示出天然左乳内动脉，14/16（87%）的患者显示出右乳内动脉。天然左乳内动脉的峰值流速为41 - 160cm/s（平均81±34cm/s），平均流速为28 - 89cm/s（平均45±17cm/s）。右乳内动脉的峰值流速为35 - 153cm/s（平均82±36cm/s），平均流速为21 - 82cm/s（平均46±22cm/s）。在19例患者中的16例（84%）显示出移植的左乳内动脉，这些患者在术后6天至36个月进行评估。舒张期峰值流速范围为24至80cm/s（平均48±17cm/s），平均舒张期流速范围为13至57cm/s（平均33±11cm/s）。吻合口远端左前降支的峰值流速为22 - 62cm/s（平均37±15cm/s），平均流速为18 - 53cm/s（平均29±12cm/s）。我们得出结论，经胸彩色多普勒超声心动图能够显示天然和移植的乳内动脉，在冠心病患者的管理中具有潜在的临床应用价值。
