PURPOSE:Multislice computed tomography (MSCT) is a noninvasive diagnostic tool that permits the visualization of the coronary artery bypassing grafts that reconstructed in 3-D image. The purpose of our study is to compare the 64 MSCT plus Transcutaneous Doppler Ultrasound (TDUS), with conventional coronary angiography (CA) for the evaluation of the bypass graft flow and patency following minimally invasive direct coronary artery bypass (MIDCAB).
METHODS:From Jan. 1997 to Aug. 2005, 55 pts underwent MIDCAB with LITA to LAD (n=44), with the right gastroepiploic artery (RGEA) to RPD (n=3), or with the LITA with a SV segment extension to the LAD (n=6), to the diagonal artery (n=1), or to RAM (n=1). There were two pts with LITA to LAD and RGEA to the RPD. Pts underwent MIDCAB due to coronary stenosis (100%, 20; 90 to 99%, 28; <90% stenosis, n=6) or unsuccessful PTCA with dissection (n=1). 53 survived patients (follow-up from 28 to 69 months, mean 40) were investigated by means of 64 MSCT and TDUS, in comparison to CA performed recently. Survived MIDCAB pts also underwent flow velocity measurement by TDUS velocimetry. And graft flows were quantified based on Doppler velocimetric data.
RESULTS:All patent grafts were assessable at 64 MSCT and were reassured by flow measurement with Doppler Ultrasound. Sometimes CA could not detect the patent ITA graft (n=2) and RGEA graft (n=1). However, all grafts which were patent at coronary angiography were correctly identified at 64 MSCT and TDUS, with a sensitivity and specificity of 100%, respectively.
CONCLUSION:ECG-gated and contrast enhanced 64 MSCT in combined use of Transcutaneous Doppler Ultrasound permits an accurate and non-invasive evaluation of bypass graft flow and patency in MIDCAB pts.
CLINICAL IMPLICATIONS:64 MSCT and US could replace the conventional coronary angiography for the follow-up of asymptomatic, stable MIDCAB pts.
DISCLOSURE:Tsung Tsai, No Financial Disclosure Information; No Product/Research Disclosure Information