MINIMALLY INVASIVE MAMMARY ARTERY DOPPLER FLOW VELOCITY EVALUATION INMINIMALLY INVASIVE CORONARY OPERATIONS

Background. Left internal mammary artery Doppler now velocity assessme nt during the Azoulay maneuver (patient's legs are passively lifted up and actively maintained by the patient) can increase the information on the anastomosis quality after left internal mammary artery to left anterior descending coronary artery grafting after the left anterior, small thoracotomy operation. Methods. One hundred patients had an earl y postoperative angiography and a Doppler now velocity assessment at r est and during the Azoulay maneuver. Peak and mean systolic velocities , peak and mean diastolic velocities, and peak and mean diastolic to s ystolic velocity ratios were recorded in all patients. Results. In 95 patients with no restrictive conduit or anastomosis, peak and mean dia stolic to systolic velocity ratios increased during the Azoulay maneuv er; all but 1 patient showed at least one ratio equal to or greater th an 1. In 4 patients with restrictive conduit or anastomosis, peak and mean diastolic to systolic velocity ratios were always less than 1 dur ing the Azoulay maneuver. In the patient with an occluded conduit thes e ratios were less than 0.6. Conclusions. Peak and mean diastolic to s ystolic velocity ratios less than 1 during the Azoulay maneuver are su ggestive of conduit or anastomosis malfunction. If we limit the angiog raphic controls to these patients, it is very likely that a pathologic anastomosis or conduit will not be missed. (Ann Thorac Surg 1998;66:1 236-41) (C) 1998 by The Society of Thoracic Surgeons.