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Using noninvasive methods of ultrasound and CT angiography to evaluate the bypass graft patency in MIDCAB patients
Tsung-Po Tsai, Jung-Ming Yu, Shoo-Chay Huang, Su-Chin Tsao, Yi-Liang Wu.
Chung Shan Medical University Hospital, Taichung, Taiwan.
OBJECTIVE:
Multislice computed tomography (MSCT) is a noninvasive diagnostic tool that permits the visualization of the coronary artery bypassing grafts that reconstructed in 3-D image. The purpose of our study is to compare the 64 or 640 MSCT plus Transcutaneous Doppler Ultrasound, with conventional coronary angiography for the evaluation of the bypass graft patency and flow following minimally invasive direct coronary artery bypass (MIDCAB).
METHODS:
From January 1997 to Dec 2010, 70 patients underwent MIDCAB with LITA to LAD (n=53), with the right gastroepiploic artery (RGEA) to RPD (n=3), or with the LITA and a saphenous vein segment extension to the LAD (n=10), to the diagonal artery (n=1), or to RAM (n=1). There were two patients with LITA to LAD and RGEA to the RPD. Patients underwent MIDCAB due to coronary stenosis (100% occlusion, n=53; 90 to 99% stenosis, n=30; <90% stenosis, n=6) or unsuccessful PTCA with dissection (n=1). Fifty three survived patients (follow-up period from 33 to 74 months, mean 44) were investigated by means of (64 or 640) MSCT and Doppler Ultrasound, in comparison to coronary angiography.
RESULTS:
Survived MIDCAB patients also underwent flow velocity measurement by Transcutaneous Doppler Ultrasound velocimetry. And graft flows were quantified based on Doppler velocimetric data. All patent grafts were assessable at 64 or 640 MSCT and were reassured by flow measurement with Doppler Ultrasound. Sometimes coronary angiography could not detect the patent ITA graft (n=2) and RGEA graft (n=1). However, all grafts which were patent at coronary angiography were correctly identified at 64 or 640 MSCT and Transcutaneous Doppler Ultrasound, with a sensitivity and specificity of 100%, respectively.
CONCLUSIONS:
ECG-gated and contrast enhanced 64 or 640 MSCT in combined use of Transcutaneous Doppler Ultrasound permits an accurate and non-invasive evaluation of bypass graft flow and patency and could replace the conventional coronary angiography for the follow-up of asymptomatic, stable pts had undergone MIDCAB.
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