经胸冠脉血流显像评价冠脉搭桥术后桥管远端血流动力学状态

目的应用经胸冠脉血流显像评价冠脉搭桥术后乳内动脉桥管远端血流状态，为评价远期桥管通畅性研究提供影像学依据。 方法分别在术前及术后超声探测左乳内动脉血流动力学参数，并与术中即时血流监测技术所测血流量进行比较。 结果术后左乳内动脉血流频谱舒张期峰值速度（Vd）、舒张期流速时间积分（VTId）及舒张期与收缩期流速时间积分比值（VTId／VTIs）均高于术前（P＜0．001）；术后经胸超声测得左乳内动脉桥管远端血流量[（35．7±13．9）ml／min]高于术中即时血流监测技术测得乳内动脉桥管吻合口近段的血流量[（30．5±9．9）ml／min]，P＜0．05。 结论术后左乳内动脉血流频谱由收缩期优势变为舒张期优势；术后经胸超声测得左乳内动脉血流量与术中即时血流监测技术测值相关性良好；经胸冠脉血流显像可以为冠脉搭桥术后乳内动脉桥管功能的随访提供一个可靠的、无创的方法。     

常规超声结合冠脉血流显像技术评价冠状动脉搭桥术后桥血管通畅性

目的应用常规超声结合冠脉血流显像技术评价冠状动脉搭桥术后桥血管通畅性.方法行冠状动脉搭桥术(左乳内动脉原位转流至左前降支)患者46例;术后检查乳内动脉桥起始段、桥血管远段(吻合口近端)、吻合口、远端及近端左前降支.分别测量各段收缩期峰值流速、舒张期峰值流速、收缩期流速时间积分、舒张期流速时间积分.结果乳内动脉原位转流术后, 桥血管起始段显示率95.65%;桥血管与自体左前降支吻合口显示率80.43%.通过测量并计算吻合口与吻合口近端桥血管流速时间积分比值以及舒张期峰值流速比值评价吻合口是否存在狭窄.结论常规超声结合冠脉血流显像技术可提供评价桥血管通畅性的直接证据,为临床随访提供一种新的无创的方法.     

冠状动脉搭桥术前后内乳动脉桥及左前降支远段血流动力学改变的超声研究

目的应用常规超声结合冠脉血流显像技术观察分析冠状动脉搭桥术前后内乳动脉桥及远段左前降支血流动力学改变.方法行冠状动脉搭桥术患者46例,于手术前后超声检查左内乳动脉,其中38例患者检查左前降支远段.结果术后内乳动脉桥起始段显示率95.65%, 由术前收缩期优势型转变为术后舒张期优势型频谱.左前降支远段血流信号表现为流速及流速时间积分增加.结论常规超声结合冠脉血流显像技术可为冠状动脉搭桥术后随访提供一种无创的方法.     

大隐静脉转流术后近期桥血管通畅性的超声研究

目的 应用冠脉血流显像技术评价大隐静脉转流术后近期桥血管通畅性.方法 13例行大隐静脉转流术的患者,桥血管近段及远端的血流参数与54例左乳内动脉桥血管对比.结果 5例患者可显示大隐静脉桥血管与升主动脉吻合口.全部患者于心脏表面可显示大隐静脉桥血管中远段.13例大隐静脉桥血管与左乳内动脉桥血管均表现为双期双相频谱,均表现为自起始段至远段收缩期流速减低,舒张期流速增高.而相同节段,左乳内动脉桥血管血流参数均大于大隐静脉桥血管.结论 冠脉血流显像技术可显示大隐静脉桥血管,提供评价桥血管通畅性的直接证据,为临床随访提供无创检查方法.     

左乳内动脉转流术后近期通畅性的超声研究

目的 应用冠脉血流显像技术结合外周血管超声评价左乳内动脉转流术后近期桥血管通畅性.方法 行左乳内动脉左前降支原位转流术患者75例,于术后1周左右观察乳内动脉桥血管起始段,远段(吻合口近端)、吻合口、远端及近端左前降支.各段均显示清晰者入选.分别测量各段收缩期及舒张期峰值流速及流速-时间积分.并计算舒张期与收缩期峰值流速比,舒张期流速-时间积分分数.依据桥血管及左前降支血流动力学特点将患者分为桥血管通畅组,吻合口狭窄组,竞争性供血组,及远端弥漫性病变组.将后三组桥血管血流参数分别与通畅组比较.结果 术后桥血管起始段显示率97.3％,乳内动脉桥血管与自体左前降支吻合口显示率97.3％.71例患者入选分组.吻合口狭窄组及竞争性供血组分别与通畅组比较,桥血管起始段血流参数有显著差异,远段无显著差异.远端弥漫病变组与通畅组比较,桥血管起始段及远段血流参数均有显著差异.结论 冠脉血流显像技术可直接显示吻合口,同时显示桥血管与自身冠脉,提供评价桥血管通畅性的直接证据.     

冠状动脉旁路移植术中与术后左内乳动脉桥血流对比分析

目的　为评估冠状动脉旁路移植术 (CABG)后患者内乳动脉桥的血流状态探索一种有效、安全及简便的检查方法。方法　对CABG术后 3 6例患者 (据左前降支狭窄程度分为两组 :1组 ,狭窄≥ 90 % ;2组 ,狭窄 <90 % )进行经胸多普勒超声检查 ,测定左内乳动脉 -前降支 (LIMA -LAD)血管桥的各项血流参数并计算出收缩期血流量、舒张期血流量和平均血流量 ,与术中即时超声血流探测仪TTFM (transit-timeflowmeter)直接测量的LIMA -LAD血管桥各期血流量分析比较。结果　①LIMA -LAD血管桥术中经TTFM检测及术后经胸多普勒超声检测 ,其舒张期血流量与舒张期血流量 收缩期血流量比值相关性较好 (r值分别为 0 .67,0 .78) ;②组间舒张期血流量 收缩期血流量比值的差异有显著性(术中P =0 .0 0 0 ;术后P =0 .0 3 8)。结论　①经胸多普勒超声可作为CABG术后检测LIMA -LAD血管桥血流特征的一项有实用价值的检测技术 ;②CABG术前前降支狭窄越重 ,CABG术后LIMA -LAD血管桥的冠状动脉血流特征越明显     

双源CT对冠状动脉桥血管的评价

【目的】评价双源螺旋CT对冠脉搭桥术后桥血管开通的诊断价值。【方法】对57例冠状动脉搭桥术后的患者行双源螺旋CT冠状动脉成像检查。【结果】所有141支桥血管均重建成功。其中内乳动脉桥39支,大隐静脉桥102支,通畅的桥血管102支（72．3％）,不同程度狭窄15支（10．63％）,完全闭塞24支（17．02％）。39支内乳动脉桥支33支通畅（84．62％）,102支大隐静脉桥支69支通畅（67．65％）,两种桥血管间相比较差异显著（P〈0．05）。【结论】双源螺旋CT是评价冠状动脉搭桥术后桥血管开通的有价值的无创检查方法。     

经胸壁多普勒超声心动图对冠状动脉血流的检测——与冠状动脉造影对照研究

目的探讨经胸壁多普勒超声心动图(TTDE)对冠状动脉远端血流检测的可行性.方法采用TTDE探查51例冠心病患者冠状动脉左前降支(LAD)远端及右冠状动脉后降支(PDA)血流,并与冠状动脉造影比较.结果 LAD的检出率为94%,PDA的检出率为75%,PDA未检出组的心率明显快于检出组.彩色多普勒冠脉显像为心底部朝向心尖部的舒张期持续的线状血流信号,脉冲多普勒显示以舒张期为主的双期血流频谱,有3例冠脉完全闭塞的患者检出舒张期负向血流.结论 TTDE可以较好地评价冠状动脉左前降支和右冠状动脉后降支血流,为临床提供一个无创的检查冠状动脉血流的新方法.     

冠状动脉血流显像评价冠状动脉搭桥术后胸廓内动脉桥通畅性的研究

目的探讨冠状动脉血流显像技术评价冠状动脉搭桥术后胸廓内动脉桥通畅性的价值。方法对左胸廓内动脉一冠状动脉搭桥术并行桥血管造影术的9例患者进行随访，其中转流至左前降支者8例，转流至对角支者1例。3例因桥血管狭窄或闭塞于造影术中行左前降支近中段支架术。在冠状动脉造影前超声探测胸廓内动脉桥起始段、冠状动脉左前降支远段，分别测量各段收缩期峰值流速、舒张期峰值流速、收缩期流速时间积分、舒张期流速时间积分。评价桥血管通畅性，并与冠状动脉造影结果进行对照分析。行支架术患者于支架术后再行超声检查，观察上述参数变化。结果超声根据桥血管起始段频谱形态诊断桥血管通畅3例，狭窄3例，桥血管功能不良2例，闭塞1例。行支架术的3例患者，2例为吻合口狭窄患者表现为支架术后桥血管舒张期流速降低，其中1例阻力增高；1例胸廓内动脉桥闭塞无改变。3例患者左前降支远段舒张期流速增高。结论常规超声结合冠状动脉血流显像技术是可行、可信、无创性探测桥血管通畅性的方法，可用于冠状动脉搭桥术后的随访。     

非体外循环冠状动脉搭桥术二例监护体会

1　病人一般情况病例 1,男 ,5 6岁 ,已婚 ,住院号 16 7979,因劳累后胸闷 5个月 ,症状加重伴心前区疼痛 3个月而入院 ,入院后冠状动脉造影示 :左冠状动脉回旋支主干及右冠脉房室支分叉处狭窄 ,诊断“冠心病 ,二支病变”。在全麻非体外循环下 ,取左乳内动脉作为左冠脉回旋支桥 ,右大隐静脉作为右冠脉房室支及对角支桥行搭桥术 ,手术 15 0ｍｉｎ ,术毕安返ＩＣＵ病房 ,行呼吸机辅助呼吸 ,多功能监护仪监测生命体征。手术后 8ｈ拔除气管插管 ,第 2ｄ进食。病例 2 ,男 ,5 8岁 ,已婚 ,住院号 16 80 2 8,因劳累后胸闷、气短、压榨性胸骨痛 10年 ,症…     

Use of the internal mammary artery for myocardial revascularization in a patient with radiation-induced coronary artery disease.

A 9-year-old boy with clinical stage IIA Hodgkin's disease underwent radiotherapy to the neck and mediastinum. Twenty-two years later, he sought medical attention because of angina pectoris. Cardiac catheterization revealed proximally located high-grade stenoses of the left main, left anterior descending, circumflex, and right coronary arteries. He underwent coronary artery bypass grafting with use of the left internal mammary artery to the left anterior descending coronary artery and reversed saphenous vein grafts to the circumflex and right coronary arteries. The postoperative course was uncomplicated. Previous radiotherapy to the mediastinum should be considered a risk factor for the development of premature coronary artery disease. Surgical revascularization is the preferred method of management. A combination of an internal mammary artery graft and a saphenous vein graft should be used in young patients.     

Intraoperative assessment of coronary grafts by novel digital epivascular imaging.

OBJECTIVE: We sought to validate and evaluate 2 novel intraoperative ultrasound probes for epicoronary and epiaortic imaging. BACKGROUND: The noninvasive intraoperative assessment of successful coronary artery bypass grafting remains a challenge. METHODS: A total of 19 consecutive patients (4 female, 15 male; mean age 60.5 +/- 13.8 years SD, range 34-84) underwent coronary artery bypass grafting. The epivascular probes (GE Ultrasound) were validated in vitro and intraoperatively. Coronary arteries, grafts, and ascending aorta were imaged and quantified. RESULTS: Mean adjusted flow measured by flowmeter was 3.25 L, SE 0.47 (range: 1-5.5 L) and was 3.15 L, SE 0.46 (range: 1-5.0 L) by ultrasound, with r = 0.97, P <.0001. Intraoperatively, 56 native coronary vessels were bypassed using 15 left internal mammary artery grafts, 25 vein grafts, and 16 venous jump grafts. A total of 15 left internal mammary artery grafts (100%), 12 left internal mammary artery anastomoses (80%), 20 vein grafts (15 left anterior descending coronary arteries, left circumflex artery grafts, 5 right coronary artery grafts) (80%), 4 jump grafts (25%), and 15 ascending aortas (78%) were successfully imaged by inexperienced surgeons. Doppler flow measurements were possible in 50 vessels (89%). Mean lumen diameter for graft arteries (veins) was 2 mm (2.87 mm), maximal velocity was 72 cm/s (46 cm/s), and mean velocity was 29 cm/s (21 cm/s) with a mean flow rate of 70 mL/m (55 mL/m). CONCLUSIONS: We conclude that: (1) the novel intraoperative probes measure validated flow; (2) intraoperative hemodynamic assessment of graft patency is feasible without a learning curve; and (3) these findings should encourage the routine use of these intraoperative epivascular digital ultrasound probes.     

Initial experience with sequential internal mammary artery bypass grafts to the left anterior descending and left anterior descending diagonal coronary arteries

Early patency and late patency have consistently been better with single internal mammary artery grafts than with saphenous vein conduits. To determine the efficacy of these two types of grafts in sequential anastomoses, we performed sequential anastomoses of the left internal mammary artery to the left anterior descending and diagonal coronary arteries in 40 patients and compared the results with those in 58 patients who received sequential saphenous vein grafts. Treatment with dipyridamole (starting 48 hours before operation) and aspirin (added 7 hours after operation) was given to the 40 patients with internal mammary artery grafts and to 32 of the 58 patients in the saphenous vein group. After the bypass procedure, mean blood flows were as follows: 68 ml/min in patients with internal mammary artery grafts, 73 ml/min in patients who received saphenous vein grafts and a placebo, and 99 ml/min in those who received saphenous vein grafts, aspirin, and dipyridamole. Early patency of sequential internal mammary artery grafts to the diagonal and left anterior descending coronary arteries was comparable to that of sequential saphenous vein grafts. Because a substantial late reduction in patency has been noted in sequential saphenous vein grafts, sequential internal mammary artery grafts may be the preferred conduit for coronary artery revascularization.     

冠状动脉搭桥术前后乳内动脉的超声检查

目的：研究冠状动脉搭桥术前后乳内动脉（ＩＭＡ）血流动力学的改变,为临床提供安全可靠的检查方法。方法：５０名ＩＭＡ－冠状动脉前降支（ＬＡＤ）搭桥术的患者于手术前后作了ＩＭＡ的超声检查。测量ＩＭＡ的收缩期峰值与舒张末期流速之比（Ｓ／Ｄ）,搏动指数（ＰＩ）,阻力指数（ＲＩ）,计算舒张期流速时间积分分数（ＤＶＴＩＦ）。将与ＬＡＤ吻合的ＩＭＡ手术前后的测值进行比较,并将术后两侧ＩＭＡ的测值进行比较,作统计学处理。结果：手术前后转流侧ＩＭＡ测值比较,血流动力学发生改变。Ｓ／Ｄ,ＰＩ,ＲＩ及ＤＶＴＩＦ均有显著性差异（Ｐ＜０．０１）。手术后转流侧ＩＭＡ与对侧比较,以上各项血流动力学测值同样有非常显著性差异（Ｐ＜０．０１）。ＩＭＡ的血流由术前的收缩期优势型转变为术后的舒张期优势。结论：超声检查在术前对ＩＭＡ可进行筛选,术后是随访转流血流通畅性可靠的无创方法。     

CT血管造影分析体外循环与非体外循环冠状动脉旁路移植后的桥血管通畅率

背景：近年来,非体外循环冠状动脉旁路移植后桥血管通畅率是否与传统的体外循环冠状动脉旁路移植相同存在争议。目的：探讨体外循环与非体外循环冠状动脉旁路移植后桥血管时间通畅率的差异性。方法：选取同一操作者行体外循环冠状动脉旁路移植患者100例,按其临床特征及桥血管病变危险因素匹配抽取非体外循环冠状动脉旁路移植患者137例。采用64排多螺旋CT血管造影分析冠脉搭桥后1个月,1年,2年,3年,4年的桥血管通畅情况。结果与结论：共对641条桥血管进行评价,两组中左侧乳内动脉桥血管时间通畅率均高于大隐静脉桥,两组左侧乳内动脉桥和大隐静脉桥血管时间通畅率比较差异均无显著性意义。说明非体外循环与体外循环冠状动脉旁路移植后患者桥血管时间通畅率相似,对于某些适当的患者来说,非体外循环冠状动脉旁路移植不失为一个良好的选择。     

Multicenter radial artery patency study (RAPS). Study design

The use of an internal thoracic artery rather than a saphenous vein graft for left anterior descending coronary artery bypass is associated with improved long-term outcome. Hence, expanded use of arterial conduits for other coronary targets has been advocated. The radial artery possesses a number of anatomic features that are technically advantageous compared with other arterial conduits. This study will determine the relative patency of the radial artery compared to the saphenous vein for right and circumflex coronary bypass. Patients with graftable multivessel coronary disease and an estimated left ventricular ejection fraction >/= 35% undergoing nonemergent primary isolated coronary bypass surgery are eligible. The right and circumflex vessels must have high-grade lesions (>/= 70% diameter stenosis), with target segments of reasonable quality >/= 1.5 mm in diameter. Patients serve as their own controls. The radial artery is randomly allocated to bypass the right or circumflex territory and a saphenous vein is used for the nonradial site. An internal thoracic artery is used for the left anterior descending coronary artery in all cases. Randomization is stratified by center. The primary study endpoint is graft patency as determined by angiography, 8-12 months postoperatively. The relative patency of the radial artery compared with the saphenous vein will be determined using McNemar's test. A sample size of 464 patients will provide 80% power for a two-tailed test (alpha = 0.05) for a 40% relative reduction in the rate of distal anastomotic occlusion from 12% in the saphenous vein to 7.2% in the radial arteries assuming a 20% within-patient correlation. A single interim analysis will be performed following completion of 232 angiograms. To allow for lack of follow-up angiography in up to 20% of enrolled patients, we plan to randomize a total of 560 patients. It is also our intention to assess the long-term patency (5-10 years) of radial artery relative to saphenous vein grafts in follow-up studies. Three hundred patients were recruited from 12 Canadian, university-affiliated sites from November 1996 until February 1999, of which 128 patients have undergone follow-up angiography. Approximately 80% of those who have been followed for more than 1 year have undergone follow-up angiography. This trial will determine the 8-12 month patency of the radial artery relative to the saphenous vein for non-left anterior descending coronary bypass using a novel study design which helps control for potential bias from individual patient and vessel factors. Positive results would support the use of the radial artery in particular, and multiple arterial grafts in general.     

Transthoracic Doppler validation in mammary artery grafts after minimal invasive direct coronary artery bypass operation.

OBJECTIVE: This study was performed to validate noninvasive transthoracic Doppler ultrasound (TTD) with simultaneous invasive Doppler guidewire measurements in patients after minimal invasive direct coronary artery bypass operation. METHODS: A total of 14 patients were examined 3 to 8 days after minimal invasive direct coronary artery bypass operation. TTD was performed to measure systolic and diastolic peak velocities of the left internal mammary artery (LIMA) at rest and during adenosine-induced hyperemia. Simultaneous Doppler guidewire measurements were performed. RESULTS: LIMA flow was detected in 12 of 14 patients (86%). There was high agreement between TTD and Doppler guidewire measurements of LIMA flow velocities (systolic peak velocity: r = 0.86, y = 11.3 + 0.82x +/- 7.9; diastolic peak velocity: r = 0.95, y = 5.7 + 1.02x +/- 7.5; average peak velocity: r = 0.95, y = 5.2 + 0.94x +/- 5.4; and flow velocity reserve: r = 0.97, y = 5.2 + 0.99x +/- 4.5). CONCLUSION: TTD represents an accurate method to evaluate flow velocities and flow velocity reserve of LIMA bypass grafts even in the early phase after minimal invasive direct coronary artery bypass operation.