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     

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.     

ANGIOGRAPHIC STUDY ON THE PATENCY OF SINGLE VERSUS SEQUENTIAL VENOUS GRAFT BEFORE REDO CORONARY ARTERY BYPASS SURGERY

Objective To compare the long-term patency and longevity of the single and sequential ve-nous graft. Methods The coronary arterial angiographic data for 300 redo coronary bypass grafting (CABG) were collected. Among them 106 cases had both single (159) and sequential (118) grafts. Results The oc-clusive and narrowness rate for the single grafts versus sequential grafts were: 1 year, 2% vs 2% ; 5 years, 3% vs 4% ; 10 years, 18% vs 19% ; 15 years, 60% vs 68% ; and 23 years, 76% vs 81% , respectively. The differences were not significant in general. Conclusion Sequential anastomosis itself does not has any adverse affects on short-term and long-term patency of the venous graft and its longevity in CABG operations in general.     

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.     

64层螺旋CT在冠状动脉旁路移植术后的诊断价值

目的探讨64层螺旋CT在冠状动脉旁路移植术后诊断桥血管及自体冠状动脉的临床价值。方法对术后2周～8年58例共140条桥血管（动脉桥43条,静脉桥97条）进行64层CT检查,以冠状动脉造影作为金标准,评价显著狭窄（管径狭窄〉50％）的桥血管及〉1．5inin管径的所有自体冠状动脉节段。结果140条桥血管中,38条闭塞,102条开通,CT全部诊断正确。102条开通的桥血管中,18条存在显著性狭窄,CT诊断敏感性100％,特异性95,2％。CT图像能够满足诊断的自体冠状动脉节段占90％。在可评价的冠状动脉节段中,以节段为单位诊断自体冠状动脉显著性狭窄的敏感性84％（87／103）、特异性74％（384／518）。临床正确诊断率为91％（53／58）。结论64层螺旋CT可准确诊断桥血管及自体冠状动脉的显著狭窄,是评价桥血管移植术后的一种无创、可靠的检查方法。     

Monitoring of antegrade selective cerebral perfusion for aortic arch surgery with transcranial Doppler ultrasonography and near-infrared spectroscopy

目的　为评估经右锁骨下动脉插管进行选择性顺行脑灌注 (ASCP)的有效性和安全性 ,作为扩展主动脉外科全身停循环的安全期限的一种手段 ,用多单位神经监测来客观地量化其生理反应。方法　择期主动脉外科病人 2 2例 ,所有病人年龄均小于 6 0岁。术前用经颅多谱勒 (TCD)确证颈动脉和锥基底动脉系统通畅和存在有效的侧枝灌注。通过右锁骨下动脉插管建立体外循环。用TCD测量大脑中动脉的峰血流速度 ,反映ASCP的幅度。同时 ,用双波长近红外线光谱仪持续监测局部脑氧饱和度 (rSO2 )。结果　所有病人恢复顺利。当ASCP流量 <5ml·kg 1·min 1时 ,则监测不到大脑中动脉血流 ,调节最低流量在 15- 2 0ml·kg 1·min 1时 ,则维持rSO2 >50 %。ASCP流量与大脑中动脉的峰血流速度和rSO2 均呈高度相关性 (r =0 86和 0 96 ,P <0 0 1)。结论　神经监测下进行ASCP可能扩展主动脉外科全身停循环的安全期限 ,至少部分与本组缺少神经并发症有关     

MR IMAGING OF CORONARY ARTERY BYPASS GRAFT:A PRELIMINARY STUDY

Ｃｏｒｏｎａｒｙａｒｔｅｒｙｂｙｐａｓｓｇｒａｆｔ(ＣＡＢＧ)ｓｕｒｇｅｒｙｈａｓｂｅ ｃｏｍｅｉｎｃｒｅａｓｉｎｇｌｙｐｏｐｕｌａｒｉｎｏｕｒｃｏｕｎｔｒｙｉｎｒｅｃｅｎｔｙｅａｒｓ .Ｔｈｅｐｏｓｔｏｐｅｒａｔｉｖｅｓｅｌｅｃｔｉｖｅｃｏｒｏｎａｒｙｇｒａｆｔａｎｇｉｏｇｒａｐｈｙｒｅ ｍａｉｎｓｔｈｅ“ｇｏｌｄｓｔａｎｄａｒｄ”ｔｏｅｖａｌｕａｔｅｔｈｅｐａｔｅｎｃｙｏｆｔｈｅｇｒａｆｔ Ｈｏｗｅｖｅｒ ,ａｓａｎｉｎｖａｓｉｖｅｍｅｔｈｏｄａｎｄｆｏｒｏｔｈｅｒｒｅａ ｓｏｎｓ,ｉｔｉｓｎｏｔｗｉ…     

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。     

冠状动脉旁路移植术后桡动脉桥血管通畅率的影响因素分析

目的 分析冠状动脉旁路移植术(CABG)后桡动脉(RA)桥通畅率的影响因素。 方法 回顾性分析在CABG术中使用RA桥,并于术后1年复查冠状动脉计算机断层扫描血管造影术(CTA)患者65例。收集患者术前、术中及术后的相关资料,采用多因素logistic回归分析筛选RA桥通畅率的影响因素。 结果 RA桥靶血管近端狭窄程度≥80%(OR=0.212, 95%CI: 0.049~0.912, P=0.037)和靶血管在左前降支区域(OR=0.104, 95%CI: 0.012~0.921, P=0.042)是RA桥术后通畅率的独立保护因素,而术后未规范联用抗痉挛药物(OR=6.825, 95%CI: 1.857~25.083, P=0.004)是RA桥通畅率的独立危险因素。 结论 CABG术中RA桥靶血管的合理选择和术后联用抗痉挛药物是RA桥通畅率的独立影响因素。     

双源CT血管造影评价冠状动脉旁路移植术后桥血管的价值

目的探讨双源CT血管造影（CTA）评价冠状动脉旁路移植术后桥血管的价值。方法对95例冠状动脉旁路移植术患者进行双源CTA检查,对所有图像进行后处理重建,包括最大密度投影（MIP）、曲面重建（CPR）、容积再现（VR）,评价桥血管的通畅情况或再狭窄程度。结果95例患者的CTA图像均符合诊断要求,清晰显示桥血管196支．其中动脉桥91支,静脉桥105支。有37支桥血管出现不同程度再狭窄,桥血管闭塞14支。结论双源CTA检查经各种后处理技术能清晰显示桥血管及冠状动脉本身,是评价冠状动脉旁路移植术后桥血管的一种准确可靠的无创检查方法。     

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.     

64排螺旋CT对冠状动脉搭桥术后桥血管评价的研究

目的评价64排螺旋CT对冠状动脉搭桥术后桥血管通畅性的随访价值。方法41例搭桥术后患者,共计104条桥血管,其中42条动脉桥,51条静脉桥,11条序贯桥血管,平均2.54条/例。所有患者在术后3～6个月进行64排螺旋CT桥血管成像检查,扫描范围自胸廓入口至左侧膈肌心尖处,层厚0.5mm,重建间隔1.0mm,螺距1.25,对比剂用量60～70ml,注射速度4ml/s,延迟时间23～28s,对所有病例图像进行后处理重建,包括最大密度投影(MIP)、多平面重建(MPR)、表面遮盖显示(SSD)、容积重建技术(VR)等。对所有图像进行观察,对桥血管通畅性或再狭窄程度进行诊断,特别是近端和远端吻合口的通畅情况。结果所有41例患者顺利完成桥血管64排螺旋CT成像检查,其中94条桥血管显影,10条未见显影血管考虑闭塞,另有10条动脉桥血管可见管壁钙化,5条动脉桥、3条静脉桥以及2条序贯桥血管可见近端或远端吻合口狭窄。结论64排螺旋CT不但能显示冠状动脉桥血管,而且能清晰地显示原始的冠状动脉及吻合口的再狭窄情况,是无创性随访搭桥术后桥血管通畅情况的有效方法。     

ANALYSIS OF 312 CASES OF REPEAT CORONARY ARTERY BYPASS GRAFTING

R啨ｓｕｍ啨　　 Objectif　 valuerler啨ｓｕｌｔａｔｄｅｓ pontagescoronariensr啨ｐ啨ｔ啨ｓｃｈｅｚ 312 patients.M啨ｔｈｏｄｅｓ　Ｌｅｓｄｏｎｎ啨ｅｓｄｅ 312malades ( gemoyen :6 5± 9ans)ayantsubidespontagescoronariensr啨ｐ啨ｔ啨ｓ劋ｌ ho^pitalHartford ,o     

非体外循环下对多支冠状动脉病变的外科治疗

目的　为避免体外循环可为冠心病患者带来严重的并发症 ,本研究对一些选定的病例采用冠状动脉旁路移植术这一新的心肌血管重建技术 ,并证明该技术安全、有效。方法　选择 5 9例血管条件较好的患者接受非体外循环下多支冠状血管搭桥术 ,患者血管病变主要累及左冠状动脉 ,且大多伴有冠心病外科手术高危因素。平均搭桥 2 .7根。结果　早期结果 :手术死亡 1例 (1.7% ) ,手术转换 2例 (3.4 % ) ,“桥”失败 1例 (1.7% ) ,术后非致命性心肌梗塞 4例 (6 .8% ) ,肾功能衰竭 1例 (1.7% ) ,胸骨感染 1例 (1.7% ) ,接受输血 19例 (32 .3% )。早期随访情况 :死亡 2例 ,心绞痛复发 4例 ,充血性心功能衰竭 1例 ;术后均无脑血管意外、再次手术止血、室上性心律失常、下肢感染和呼吸衰竭等并发症。平均住院日减少 1.3d ,用血量减少 5 0 % ,住院费用减少 1/ 3。随访病例中行冠状动脉血管造影术 4 7例 ,其中仅 2 .6 %的血管桥狭窄大于 5 0 % ,所有胸廓内动脉血管桥均通畅。结论　对具有冠心病的外科手术高危因素、多支冠状动脉病变者 ,采用非体外循环下冠心搭桥术 ,可以降低术后并发症的发生率及手术死亡率。该技术仅适用于冠状动脉解剖条件较好的病例 ,且其远期结果需要长期随访证实     

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     

Coronary bypass revascularization with radial artery and internal mammary artery grafts

Objective To evaluate radial artery (RA) and internal mammary artery (IMA) grafts in coron ary artery bypass and the use of color Doppler ultrasound in the peri- operative evaluation of IMA and radial- ulnar collateral circulation. Methods From June 1998 to June 2000, sixty cases of coronary bypass revascularization wi th RA and IMA were performed. Preoperatively, the radial- ulnar collateral circ ulation was evaluated with the modified Allen’s test, color Doppler ultrasound a nd noninvasive oxygen saturation measurement. The IMA lumen and blood flow were measured at the first intercostal space with color Doppler ultrasound preoperat ively and postoperatively. Results One patient (1. 7%) died of serious cardiac arrhythmia on the fourth postoperati ve day. There were no arterial graft harvest related complications. Before har vesting, the ulnar artery blood flow was 30. 78±9. 71 ml/min, and it increased to 43. 36±13. 98 ml/min (40. 87% increase, P&lt;0. 01) after the operation. Compared with the baseline, there was no obvious change of IMA blood flow posto peratively (P&gt;0. 05), but the systolic/diastolic flow ratio markedly dec reased from 8. 57±3. 98 ml/min to 3. 41±4. 87 ml/min (P&lt;0. 01). Conclusions Arterial grafts can be safely used for coronary bypass revascularization with go od results. The ulnar artery blood flow can increase compensatively after RA ha rvesting. The diastolic blood flow of grafted IMA markedly increased postoperat ively. Color Doppler ultrasound was very helpful both in evaluating the radial - ulnar collateral circulation before RA harvesting and in assessing the patency of the grafted IMA after coronary artery bypass grafting (CABG).     

生物血管异种移植的初步研究

目的为了寻求一种新的小口径血管代用品,建立异种移植的动物实验模型,以观察异种移植物的安全性、可靠性、通畅性及组织学改变。方法共采用17只杂种雌性犬,实验组10只,植入经环氧化物处理的猪血管移植物;对照组7只,植入人造血管。手术方法为右侧股动静脉瘘。术后通过超声和血管造影方法来观察移植血管的通畅性,并在术后3月将移植物取出,进行病理学检查,观察移植前后移植物的组织学改变。结果术后第一周、二周行Doppler超声检查结果,两组动静脉瘘均通畅,2周内血管通畅率为100%。术后3个月动脉造影检查后,生物血管组(PG)通畅5只,通畅率62.5%,e-PTFE组通畅4只,通畅率66.7%。两组数据统计学处理,差异无显著性(P>0.05)。术后3月对移植物取材,进行光镜及扫描电镜病理学检查,通畅的生物血管吻合口无狭窄,吻合部位有新的内膜覆盖,周围组织无钙化,有新生的内皮细胞覆盖。结论经环氧化物处理的猪的血管移植物(PG)生物血管作为异种移植物,生物相容性好,具有一定的可行性。     

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。