ROLE OF TRANSCUTANEOUS ULTRASOUND IN EVALUATION OF GRAFT PATENCY FOLLOWING MINIMALLY INVASIVE CORONARY SURGERY

Objective: Recent development in minimally invasive coronary surgery p rompted us to carry out prospective evaluation of patients undergoing coronary artery: bypass grafting through left anterior small thoracoto my. Methods: Between April 1996 and February 1997, 15 patients (age 32 -70, 12 male) were operated on. The left internal thoracic artery (LIT A) basal now was assessed by means of transcutaneous Duplex ultrasound scanning with pulsed waved Doppler. Eight patients were studied in th e immediate postoperative period (:2-4 days) and seven patients (1-7 m onths) following revascularisation. In addition to that, nine patients underwent coronary angiography, Results: LITA graft flows were quanti fiable in all 15 patients. In two patients there was a significant red uction in both time-averaged velocity and total now. The subsequent co ronary angiogram revealed severe (>50%) stenosis of LITA,graft in both patients. One of these patients had a reversible obstruction document ed by Duplex scanning and coronary angiography. Systolic measures did not differ between normal (13) and stenosed grafts (2), bur diastolic time-averaged velocity (indicating coronary run-off) and total flow ap peared lower in the latter. Conclusions: LITA now following left anter ior small thoracotomy surgery can be evaluated non-invasively. Measure ment of diastolic now (i.e. coronary perfusion rather than internal th oracic branch run-off) and total Bow is useful in estimating graft fun ction. (C) 1998 Elsevier Science B.V. All rights reserved.