CT and arteriography in the evaluation of indirect myocardial revascularization with a free-muscle transplant: Initial experience

PURPOSE: To examine patients with advanced cardiovascular disease with radi ology after indirect myocardial revascularization with a free-skeletal-musc le transplant and to determine whether the attached vessel remains patent o ver the middle and long terms. MATERIALS AND METHODS: In 10 patients with advanced, inoperable cardiovascu lar disease treated with indirect myocardial revascularization with a free- muscle transplant, radiologic follow-up was performed postoperatively and e very 6 months. All 10 patients underwent selective arteriography of the ana stomosed vessel and contrast material-enhanced helical computed tomography (CT) (transverse sections and reconstructions). RESULTS: All patients showed adequate vascular conditions postoperatively, as did nine of 10 patients after 1 year. In one patient, the anastomosed ar tery was occluded. CT showed time-dependent muscle degeneration in all pati ents. Postoperative, contrast-enhanced, superselective CT showed an area of high-attenuating uptake in the muscle transplant in all patients. After 1 year, CT depicted perfusion defects of the skeletal muscle in two patients. In eight patients, however, small vascular bridges from the skeletal muscl e to the myocardium were detected. Radiologic results correlated well with clinical outcome and stress electrocardiograms. CONCLUSION: Helical intraarterial CT and arteriography were sensitive in de picting enhancement and remaining vital function in nine of 10 patients aft er indirect myocardial revascularization with a free-muscle transplant. Thi s combination seems promising for postoperative examination in such patient s.