Three-dimensional reconstruction of electron beam computed tomography angiography for evaluating coronary artery bypass grafts

OBJECTIVES: To probe into electron beam computed tomography (EBCT) angiography and 3-D reconstruction of coronary artery bypass grafts (CABG) and to evaluate the clinical application of EBCT angiography and 3-D reconstruction of CABG. METHODS: EBCT angiography with 3-D reconstruction was achieved in 150 patients (142 men and 8 women, mean age, 57 +/- 8 years) with 399 grafts including 100 internal mammary artery grafts (IMG), 296 saphenous vein grafts(SVG) and 3 radial artery grafts (RAG) respectively. The time from bypass surgery to EBCT scanning ranged from 7 days to 120 months, averaging 15 +/- 28 months. Enhanced single slice mode (SSM) and flow studies were performed in all patients. The results of 3-D reconstruction of CABG were compared with bypass operation records and with coronary arteriograms (7 patients). RESULTS: 150 patients underwent successfully EBCT angiography and CABG 3-D reconstruction. According to 3-D reconstruction of the coronary bypass grafts with flow studies, 318 of 399 coronary bypass grafts were patent including IMG patency in 87/100 (87%), SVG in 228/296 (77%) and RAG in 3/3 (100/100). The overall patent rate was 79.7%. In 7 patients with 12 coronary bypass grafts, EBCT studies showed graft patency (7 grafts) and occlusion (5), which were confirmed by conventional graft angiography. CONCLUSIONS: EBCT angiography with 3-D reconstruction is effective in providing the entire anatomic structure of coronary bypass grafts and evaluating coronary bypass graft patency. EBCT flow study can provide quantitative data for evaluating coronary bypass graft patency and for supplemental diagnosis of CABG 3-D reconstruction. EBCT angiography is a noninvasive technique that could replace conventional coronary arteriography for follow-up survey of coronary bypass surgery in future.     

电子束计算机断层血管造影及三维重建在冠状动脉搭桥术后的临床应用

目的探讨电子束计算机断层（ＥＢＣＴ）血管造影及三维重建在冠状动脉搭桥术后的临床应用价值。方法均采用单层增强扫描（ＳＳＭ）和血流扫描（ＦＬＯＷＳＴＵＤＹ）；三维重建采用表面阴影显示法（ＳＳＤ），并与手术结果做了对照，其中７例有术后造影检查结果。结果１５０例ＥＢＣＴ扫描及三维重建均获得成功；３９９支搭桥血管中有３１８支显示通畅，通畅率为７９７％；其中，１００支乳内动脉桥中８７支通畅（占８７％），２９６支大隐静脉桥中２２８支通畅（占７７％），３支桡动脉桥全部通畅（１００％）。７例患者ＥＢＣＴ结果显示１２支桥有５支发生了阻塞，与其造影结果一致。结论ＥＢＣＴ是评价搭桥血管通畅与否的很有价值的无创方法，并有望取代常规心血管造影。     

电子束计算机断层血管造影及三维重建在冠状动脉搭桥术后的临床 …

目的 探讨电子束计算机断层（ＥＢＣＴ）血管造影及三维重建在冠状动脉搭桥术后的临床应用价值。方法 均采用单层增强扫描（ＳＳＭ）和血流扫描（ＦＬＯＷ ＳＴＵＤＹ）;三维重建采用表面阴影显示法（ＳＳＤ）,并与手术结果做了对照,其中７例有术后造影检查结果。结果 １５０例ＥＢＣＴ扫描及三维重建均获得成功;３９９支搭桥血清血管中有３１８支显示通畅,通畅率为７９．７％;其中,１００支乳内动脉桥中８７支通畅（占８     

Evaluation of coronary artery bypass graft patency using three-dimensional re construction and flow study of electron beam tomography

目的　建立并评价电子束CT (EBT)两种方法在冠状动脉搭桥术后 (CABG)随访应用中的价值。方法　本组共 2 14例CABG患者进行了EBT两种方法的扫描 :(1)电子束CT血管造影 (EBA) ,以完成冠状动脉及搭桥血管的三维重建 ;(2 )电子束CT血流扫描 ,以得到冠状动脉及其搭桥血管的血流曲线。结果　本组共分析了 589条冠状动脉搭桥血管 (10条血管因图像伪影而除外 )。 133条动脉材料的血管桥通畅率超过静脉桥 (P <0 0 0 1)。三维重建方法诊断的敏感性、特异性和准确性分别是 97 7%、94 1%和 96 7% ,均高于血流扫描方法 (分别是 88 4 %、82 4 %和 85 2 % )。动脉与静脉血管桥内的平均血流量分别为 4 9± 2 2ml·min 1·g 1和 6 9± 2 8ml·min 1·g 1(P <0 0 0 1)。结论　电子束CT血管造影配合三维重建方法有利于观察冠状动脉及其搭桥血管的解剖 ,而血流扫描方法有利于观察并定量评估搭桥血管内的血流 ,两种方法的结合是理想的冠状动脉搭桥术后随访的无创影像方法     

Role of radial artery in total arterial myocardial revascularization in coronary bypass surgery

Background Total arterial revascularization （TAR） was widely utilized in coronary artery bypass grafting （CABG） as a result of its better long-term effect compared with vein grafts. Of the arterial conduits, radial artery （RA） gained popularity for its easy availability and reported long-term patency. Thus, the objective of this study was to investigate the effect of RA in TAR in CABG.
Methods From January 2000 to December 2006, 85 patients （56 male and 29 female） at a mean age of 57.0 ± 5.2 years, underwent TAR in CABG. RA and left internal mammary artery （LIMA） with composite Y or T and sequential grafting techniques were used. Post-operative complications were recorded and follow-up was performed.
Results Eighty-five LIMA and 149 RA grafts including 21 single and 64 bilateral RA were collected. A total of 87 distal anastomoses were done with the LIMA and another 152 were done with the RA, with the mean number of distal anastomosis per patient of 2.81 ± 0.47. The proximal RA ends were anastomsed directly to the aorta in 140 grafts with Y or T graft off in situ LIMA in 9, Y or T graft off RA in 9. The distal end was anastomsed to right coronary artery system in 92 to obtuse margina in 46, to diagonal in 19 and to ramous intermedius in 5. Nine sequential anastomoses were performed with RA. Nine composite Y or T grafts were constructed with RA and LIMA while another 9 were constructed with RA and RA. One （1.2%） patient died, 3 patients （3.5%） experienced acute renal failure and 2 （2.4%） developed stroke. All patients were still alive and no patient had evidences of newly occurred myocardial infarction or angina after a mean follow-up of 36.5 ＋ 4.1 months （6-67 months）. Postoperatively at 6 month, mean left ventricular ejective fraction was increased to 0.49 ±0.09, compared with that of 0.43 ± 0.11 preoperatively （P=-0.027）. Postoperative mean New York Heart Association class was 2.5±0.5, compared with that of 3.0±0.4 preoperatively （P=-0.003）.
Conclusions T     

64排螺旋CT对冠状动脉搭桥术效果的评价作用

【目的】研究64排螺旋CT冠状动脉成像在冠状动脉搭桥术后随访中的应用价值。【方法】对126人次冠状动脉搭桥术后6个月～2年患者(共348支桥血管)行64排螺旋CT冠脉成像,观察桥血管近端吻合口、桥血管本身和吻合口远端引流血管的通畅性。采用5分制计分法评价冠状动脉及桥血管的轴位多平面重建图像。【结果】图像平均质量达到优良水平,348支桥血管中有295支显示通畅,通畅率为84.77%,53个桥血管有狭窄,10个桥血管闭塞,闭塞率为2.87%,5例桥血管内有支架。【结论】64排螺旋CT可作为冠状动脉搭桥术后随访观察和了解搭桥术后效果的重要手段。     

Sequential Vein Bypass Grafting is Not Associated with an Increase of Either In-hospital or Mid-term Adverse Events in Off-pump Coronary Artery Bypass Grafting

Background:The impact of sequential vein bypass grafting on clinical outcomes is less known in off-pump coronary artery bypass grafting (CABG).We aimed to evaluate the effects of sequential vein bypass...     

小隐静脉用作冠状动脉旁路移植材料

目的尝试应用小隐静脉作为冠状动脉旁路移植材料或旁路移植材料不足时的补充.方法6例患者应用No-touch技术获取小隐静脉7条,作为端侧或者序贯吻合的旁路材料.结果所有小隐静脉旁路长度合适、直径适当、流量满意、患者无相关并发症.结论小隐静脉获取容易,其长度和解剖特点均适合作为2次手术或无合适大隐静脉患者的冠状动脉旁路移植材料.     

左主干行冠状动脉旁路移植手术中远期效果分析

目的 总结2002~2008年行冠状动脉旁路移植手术的冠心病左主干患者远期桥血管通畅率。 方法 2002~2008年冠心病左主干患者行冠状动脉旁路移植术共73例,男性57例,女性16例,患者年龄65.7±8.1岁。包括心肌梗死31例、左心室室壁瘤11例,合并瓣膜病变4例,术前使用主动脉气囊反搏(IABP)5例。行急诊冠状动脉旁路移植术共5例,冠状动脉旁路移植术+瓣膜置换术共4例,冠状动脉旁路移植术+室壁瘤切除并左心室成形术共6例,机器人冠状动脉旁路移植术1例。其中体外循环下手术65例,非体外循环手术8例。左乳内动脉与左前降支吻合,大隐静脉与靶血管吻合,静脉吻合口超过两个(含)时做序贯吻合。术后随访行冠状动脉64-CT或冠状动脉造影复查桥血管通畅率。 结果 术后死亡2例(病死率2.7%),死因分别为恶性心律失常和多器官衰竭。痊愈出院71例,随访患者53例,失访18例,随访率74.6%,随访时间4个月~11年,平均随访时间73.2±30.2个月。随访期间死亡8例,其中3例为心源性死亡,心源性病死率5.7%,余者为其他疾病死亡。10例再发心绞痛,2例心肌梗死,2例脑梗死。 39例患者行桥血管CT或造影,动脉桥通畅率97.4%,静脉桥通畅率82.8%。 结论 冠心病左主干患者病情重,行冠状动脉旁路移植术可有效改善冠脉血运,远期效果良好。     

Midterm Follow-up of Coronary Artery Bypass Grafting with 64-Slice Multi-detector Computed Tomography:Identification of Risk Factors Affecting Graft Patency

Objective To identify the risk factors that are associated with the midterm coronary artery bypass grafting (CABG) functionality by assessing patency of left internal mammary artery (LIMA) graft and saphenous vein (SV) graft with 64-slice multi-detector computed tomography (64-MDCT). Methods Patients who underwent CABG operation and postoperative 64-MDCT follow-up examinations from August 2012 to December 2015 were included. The graft patent status was classified into patent and poor patent according to MDCT findings predominantly on 3D reconstructed images by two radiologists. The clinical data and imaging findings of the patients were collected and compared between the patent group and poor patent group. Univariate analysis and the multivariate logistic regression analysis were performed to identify the risk factors that affect graft patency. Results Among 341 patients in the study, there were 330 LIMA grafts [326 anastomosed to the left anterior descending artery (LAD), 4 to right coronary artery (RCA)] and 564 SV grafts (SVG) [100 anastomosed to the diagonal branch (D), 226 to the obtuse marginal branch (OM), and 238 to the RCA territory]. The approximal vessel stenosis exceeding 90% occurred in 268 of 292 patent LIMA grafts, and in 1 of 34 poor patent grafts (χ2=167, P<0.001). The patency rate was higher when SVG was anastomosed to OM (85.4%) or RCA territory (81.9%) than to D (69.0%) ( χ2=15.471, P=0.004). The proximal target vessel stenosis<90% ( OR=0.015, 95% CI: 0.01-0.14, P=0.000) was independently associated with the closure risk of LIMA grafts, the dyslipidemia (OR=1.52, 95% CI: 1.0-2.5, P=0.048), history of diabetes (OR=1.28, 95% CI : 0.90-2.26, P=0.045) and typical angina symptoms (OR=1.81, 95% CI :1.33-4.15, P=0.003) were independently associated with the closure risk of SVG. Conclusions The proximal LAD stenosis less than 90% was adversely associated with graft patency in LIMA recipients; dyslipidemia, diabetes and angina symptoms were associated with the midterm failure in SVG recipients. The choice of the target anastomosis sites may affect the patency of SVG.     

MR IMAGING OF CORONARY ARTERY BYPASS GRAFT： A PRELIMINARY STUDY

Objective. To make a preliminary investigation of the patency and function of coronary artery bypass grafts (CABG) by magnetic resonance(MR) images and to establish a suitable method for follow-up study after CABG operation among Chinese. Methods. MR imaging was performed with a Toshiba 1.5-T unit in 27 patients with 74 grafts. All patients were examined with a breath-hold ECG-gated two-dimensional fast field echo (FFE) sequence to evaluate the patency of bypass grafts, among them 16 patients with 42 grafts were further examined with a phase shift magnetic resonance angiography flow (PSMRAflow) sequence to evaluate the grafts patency as well as the flow velocity and flow volume vs.time. Results. The results showed that 66 of the 74 grafts in the patients of the present series studied with FFE were patent with a patency rate of 89.2%. The results evaluated both with FFE and PSMRAflow remained the same except that two grafts were patent with FFE and the results with PSMRAflow were uncertain. Diastolic perfusion pattern curves were found in 25 of the 32 grafts in patients of the present series. Comparing the flow curves of the grafted left internal manmmry artery with those of the native right internal mammary artery in 7 patients, the systolic peak velocity value (SPV) of the grafted arteries was significantly lower than that of the ungrafted ones, whereas the diastolic peak velocity value(DPV) and the ratio of DPV to SPV were significantly greater than that of the ungrafed ones. Conclusion. The FFE and PSMRAflow sequences were efficient in evaluating patency and obtaining the curves of flow velocity and volume of the bypass grafts. Therefore, they may offer a non-invasive screening method for follow-up study in patients after CABG surgery, although its accuracy should be further evaluated in more patients and comparatively studied with other methods.     

双源CT在冠状动脉旁路移植术后随访中的应用

目的 探讨双源CT在冠状动脉搭桥术后的临床应用及其价值.方法 对2009年1月～2010年8月期间27例冠状动脉搭桥术（CABG）后患者的CTA影像资料进行分析,对桥血冠状动脉管狭窄进行诊断.其中有10例患者同期行选择性冠状动脉造影术.结果 所有患者顺利完成冠状动脉图像采集,所有桥血管均显影,并且都可进行评价,其中共15条桥血管出现狭窄.和CAG结果相比,双源CT对狭窄判断的敏感性100%、特异性91.3%、准确率93.1%,出现狭窄的血管与血管类型有关,2年内通畅率动脉桥高于静脉桥.结论 双源CT可以准确评价冠状动脉桥血管通畅情况,是术后评价冠状动脉桥血管病变的首选检查方法.     

CABG术后症状复发患者的冠脉造影特征和缺血原因分析

目的:分析总结冠状动脉旁路移植术(CABG)术后症状复发患者的冠状动脉造影(CAG)特点,并探讨心肌缺血原因及其治疗对策。方法:对74例CABG术后心肌缺血复发患者行冠状动脉造影及桥血管造影。结果:74例患者中男性72例,女性7例,平均年龄(63.3±9.3)岁,平均复查时间(37.79±37.65)个月。74例患者共174支移植血管,其中左乳内动脉桥(LIMA)44支,大隐静脉桥126支,桡动脉桥4支。LIMA完全闭塞20.5%,狭窄18.2%;静脉桥闭塞40.5%,狭窄7.9%;4例桡动脉搭桥,2例有狭窄;竞争血流现象的发生率为12.2%;32.5%的患者自体冠脉病变加重;13.5%的患者存在再血管化不完全;CABG术后早期(1个月以内)心肌缺血的主要原因是LIMA吻合口狭窄(占50%),1年以内主要与静脉桥血管狭窄和闭塞有关(共占44.7%),而1年和5年以后则绝大多数缘于静脉桥的闭塞(占50%)。狭窄移植血管的PCI成功率接近90%。结论:CABG后部分患者移植血管可以发生狭窄或完全闭塞。移植血管病变是引起术后心肌缺血复发的主要原因。     

50例冠状动脉搭桥术的临床研究

目的：观察冠状动脉搭桥术的临床疗效。方法：选择经内科治疗仍反复心绞痛发作或不适于PTCA等治疗的冠心病人50例,均在体外循环,心脏停跳下行冠状动脉搭桥术,选用的血管桥包括大隐静脉,乳内动脉和桡动脉,共搭145根桥,平均每例2．9支桥,5例同时行室壁瘤切除或成形术。结果：治愈48例,死亡2例,48例长期随访,效果良好,结论：对有冠脉搭桥指征的病人行搭桥手术,疗效安全可靠, 远期效果好。     

Cost performance and efficacy of off-pump coronary artery bypass grafting

Off-pump coronary artery bypass grafting (Off-Pump CABG) may provide an alternative form of surgical revascularization by avoiding the unwanted complications of cardiopulmonary bypass, particularly in high-risk patients. To clarify the efficacy and cost performance of Off-Pump CABG, we studied the postoperative course of Off-Pump CABG and compared it to On-pump coronary artery bypass grafting (On-Pump CABG). From Aug. 1998 to Feb. 2002, twenty-eight patients who had preoperative complications such as cerebral vascular disease (11), chronic renal failure (4), atheromatous aorta (4), one lung (1), severely impaired left ventricular function (6), re-do CABG (1), and cancer (1) underwent Off-Pump CABG. Another thirty-six patients who underwent On-Pump CABG served as a control. The Off-Pump CABG patients were almost the same age as the On-Pump CABG patients (68 +/- 8 vs 64 +/- 8 years, ns). The Number of grafts was similar in both groups (2.6 +/- 1.0 vs 2.9 +/- 1.0, ns). Peak CK, peak CKMB, peak LDH, and peak GOT release were significantly lower in the Off-Pump CABG group compared with the On-Pump CABG group. Graft patency rates were similar in both groups (98% in Off-Pump CABG vs 98% in On-Pump CABG). The total cost for surgery and patient care was significantly lower (p < 0.0001) in the Off-Pump CABG group (dollar 21000 +/- 7000) compared with the On-Pump CABG group (dollar 33000 +/- 4200). Off-Pump CABG is less invasive to the myocardium, is less expensive, and has a similar efficacy in comparison with On-Pump CABG.     

动脉化冠状动脉搭桥术循证医学认识

为提高、促进循证医学在冠状动脉搭桥术中的认识和实践,运用循证医学的基本思想分析冠状动脉搭桥术所用移植材料由大隐静脉逐渐向动脉衍变的历史。循证医学的基本思想和实践对冠状动脉搭桥术所用移植材料由大隐静脉逐渐向动脉衍变,进而提高术后远期通畅率、远期生存率和无心脏事件发生率有重要的指导意义。所以临床上应遵循循证医学的基本思想,使用动脉移植物,显著提高冠状动脉搭桥术的疗效。     

Graft patency in off-pump and conventional coronary artery bypass grafting for treatment of triple vessel coronary disease

Inanattempttoavoidthedeleteriouseffectsofcardiopulmonarybypass (CPB) ,off pumpcoronarybypasssurgeryhasrecentlybeenrediscoveredandrefined Overthepastdecade ,theuseofoff pumporbeating heartcoronaryarterybypass (OPCAB)surgeryhassincebecomemorepopularandwidelyused Intriplevesseldisease ,accesstothelateralandposteriorwallvesselstofacilitatecompleterevascularizationevolved ,accompaniedbytechnicaladvancesintheinstrumentationforstabilizationoftheheart Multiplepreviousauthorshavereportedaseriesofoff…     

再次冠脉旁路移植手术

再次冠脉旁路移植手术有越来越多的趋势。成功的再手术取决于周详的手术计划、合理的技术设计和娴熟的手术技巧，包括合适旁路的采取、再开胸技术、转流管理和心肌保护；先期旁路血管的处理、目标血管的操作、移植血管的选择、血管吻合和血液保护技术。再手术的术后死亡率约是初次手术的至少2倍，再手术后的5年生存率约90％，二次手术病人心绞痛症状的缓解并不如初次手术明显，术后5年只有一半的病人症状缓解，应用内乳动脉的再手术其长期通畅率较高。     

ANALYSIS OF 312 CASES OF REPEAT CORONARY ARTERY BYPASS GRAFTING

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内窥镜下采集大隐静脉作为冠状动脉旁路移植手术序贯桥的近期疗效

目的评价内窥镜下采集大隐静脉作为序贯桥血管的近期临床效果。方法回顾性分析应用静脉序贯桥行非体外循环冠状动脉旁路移植手术(OPCAB)并完成随访的241例患者的临床资料,根据大隐静脉取材方式将患者分为内窥镜静脉采集(EVH)组85例和开放静脉采集(OVH)组156例,比较2组术后1年时下肢水肿范围、患者满意程度评分、临床预后(死亡、新发心肌梗死、再血管化)、桥血管通畅率。结果 2组性别、年龄、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、陈旧心肌梗死、高血压、左主干病变等比较差异无统计学意义(P>0.05),而EVH组体质量指数、糖尿病比例高于OVH组,差异有统计学意义(P<0.05)。与OVH组比较,EVH组序贯桥血管支数、序贯桥主干流量、主干搏动指数、每支桥血管流量和每支桥搏动指数等差异无统计学意义(P>0.05)。EVH组手术下肢水肿比例和程度均降低、患者满意度提高(P<0.05)。2组术后1年新发心肌梗死、再血管化及桥血管通畅率差异无统计学意义(P>0.05)。结论 CABG术中采取EVH采集小腿大隐静脉作为序贯桥血管能有效降低下肢水肿,提高患者满意度,但并不影响序贯静脉桥1年通畅率。