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。

Patency of left internal thoracic artery after bypass surgury by comparison with coronary artery angiography

Objective To evaluate the patency of the left internal thoracic artery(LIMA) after coronary artery bypass graft(CABG) by coronary artery angiography. Methods Nine patients who had undergone CABG were followed up by coronary artery angiography. Three cases with the bridge blood vessels stenosis or occlusion were implanted with the stent in the proximal segment of left anterior desending artery(LAD). Before the angiography the proximal segment of the LIMA, the distal of LAD were detected by normal ultrasound and color Doppler coronary flow imaging(CDCFI) respectively, and systolic peak velocity, diastolic peak velocity, systolic velocity time integral, diastolic velocity time integral of each segment were measured to access the pateny of the bridge blood vessles in comparison with those by angiography. Three cases with stent implanted were detected above-mentioned parameters again after angiogrphy. And their change of the pharameters were observed. Results~Judged with the shape of the spectrum in the original segment, the bridge blood vessles in 3 cases were patent, 3 were stenosis, 2 were dysfunction, 1 was occlusive. The results of ultrasound diagnosis were in accordance with those of angiography in 8 cases. While in 1 case, ultrasonography result suggested bridge stenosis, but angiography appeared patent. Among the 3 patients with stent implanted, 2 cases of bridge stenosis had a lower diastolic velocity of bridge vessles and 1 of them had a higher resistance, the case of bridge occlusion had no change. The diastolic velocity of distal LAD increased in all the 3 patients. Conclusions Normal ultrasound combined with CDCFI is a feasible, reliable, non-invasive method to detect the patency of the bridge blood vessels, which can be applied to the follow-up after CABG.