Noninvasive assessment of left internal mammary artery graft patency using duplex Doppler echocardiography from supraclavicular fossa

Department of Cardiology, Kobe General Hospital, Japan.

OBJECTIVES. The purpose of this study was to clarify the usefulness of duplex Doppler echocardiography from the supraclavicular fossa for assessment of left internal mammary artery graft patency. BACKGROUND. A noninvasive method to assess coronary artery bypass graft patency would be useful for clinical diagnosis and long-term follow-up of graft outcome. METHODS. Duplex Doppler echocardiography from the supraclavicular fossa was performed in 56 consecutive patients who underwent postoperative cardiac catheterization studies, including quantitative angiography. All patients underwent coronary artery bypass graft surgery using the left internal mammary artery graft to the left anterior descending coronary artery. RESULTS. The left internal mammary artery graft and its flow were detected in 55 (98%) of the 56 patients with duplex Doppler echocardiography from the supraclavicular fossa. According to the quantitative angiographic data, the patients were assigned to three groups: group A (36 patients) with a normal left internal mammary artery graft (< 50% diameter stenosis), group B (9 patients) with intermediate (50% to 75% diameter) graft stenosis and group C (10 patients) with severe (> 75% diameter) graft stenosis. The diastolic/systolic peak velocity ratio was smaller in group C than in groups A and B (p < 0.05), but there was no significant difference between groups A and B. A diastolic/systolic peak velocity ratio < 0.6 predicted severe left internal mammary artery graft stenosis (> 75% diameter stenosis) with a sensitivity and specificity of 100% and 80%, respectively. The diastolic fraction of time-velocity integral was smaller in group C than in groups A and B (p < 0.05), but there was no significant difference between groups A and B. A diastolic fraction < 0.5 predicted significant left internal mammary artery graft stenosis (> 75% diameter stenosis) with a sensitivity and specificity of 90% and 100%, respectively. CONCLUSIONS. Duplex Doppler echocardiography from the supraclavicular fossa is useful for noninvasive assessment of left internal mammary artery graft patency.

This article has been cited by other articles:

				N I Stauder, B Klumpp, H Stauder, G Blumenstock, M Fenchel, A Kuttner, C D Claussen, and S Miller Assessment of coronary artery bypass grafts by magnetic resonance imaging Br. J. Radiol., December 1, 2007; 80(960): 975 - 983. [Abstract] [Full Text] [PDF]

				C. M. Jones, T. Athanasiou, P. P. Tekkis, V. Malinovski, S. Purkayastha, A. Haq, J. Kokotsakis, and A. Darzi Does Doppler echography have a diagnostic role in patency assessment of internal thoracic artery grafts? Eur. J. Cardiothorac. Surg., November 1, 2005; 28(5): 692 - 700. [Abstract] [Full Text] [PDF]

				N. I. Stauder, M. Fenchel, H. Stauder, A. Kuttner, A. M. Scheule, U. Kramer, C. D. Claussen, and S. Miller Assessment of minimally invasive direct coronary artery bypass grafting of the left internal thoracic artery by means of magnetic resonance imaging J. Thorac. Cardiovasc. Surg., March 1, 2005; 129(3): 607 - 614. [Abstract] [Full Text] [PDF]

				F. Pizzuto, P. Voci, E. Mariano, P. E. Puddu, A. Aprile, and F. Romeo Evaluation of flow in the left anterior descending coronary artery but not in the left internal mammary artery graft predicts significant stenosis of the arterial conduit J. Am. Coll. Cardiol., February 1, 2005; 45(3): 424 - 432. [Abstract] [Full Text] [PDF]

				M.-H. Song, M. Ito, S. Toki, K. Tanaka, W. Kato, J. Iwase, and K. Tajima Echocardiographic Evaluation of Internal Mammary Artery Graft Patency Asian Cardiovasc Thorac Ann, June 1, 2004; 12(2): 130 - 132. [Abstract] [Full Text] [PDF]

				N. Hirata, N. Asaoka, A. Amemiya, S. Hatsuoka, T. Ueno, and Y. Kosakai Noninvasive evaluation of internal thoracic artery and left anterior descending coronary artery anastomotic sites using transthoracic Doppler echocardiography: comparison with coronary arteriography J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 1080 - 1086. [Abstract] [Full Text] [PDF]

				T.-P. Tsai, K.-C. Ueng, J.-M. Yu, Y.-C. Chang, and Y.-L. Wu Comparison of the Postoperative Blood Flow Waveforms of the Bypassing Grafts in Patients Following Minimally Invasive Direct Coronary Artery Bypass Chest, March 1, 2002; 121(3): 951 - 956. [Abstract] [Full Text] [PDF]

				J.M. Hartman, J.C. Kelder, R.G.A. Ackerstaff, F.E.E. Vermeulen, and A.J.J.C. Bogers Differences in LIMA Doppler characteristics for different LAD perfusion areas Eur. J. Cardiothorac. Surg., December 1, 2001; 20(6): 1135 - 1141. [Abstract] [Full Text] [PDF]

				F Chirillo, A Bruni, G Balestra, C Cavallini, Z Olivari, J D Thomas, and P Stritoni Assessment of internal mammary artery and saphenous vein graft patency and flow reserve using transthoracic Doppler echocardiography Heart, October 1, 2001; 86(4): 424 - 431. [Abstract] [Full Text] [PDF]

				N. Ishida, H. Sakuma, B. P. Cruz, T. Shimono, T. Tokui, I. Yada, K. Takeda, and C. B. Higgins MR Flow Measurement in the Internal Mammary Artery-to-Coronary Artery Bypass Graft: Comparison with Graft Stenosis at Radiographic Angiography Radiology, August 1, 2001; 220(2): 441 - 447. [Abstract] [Full Text] [PDF]

				B. Dubey, A. Bhan, S. K. Choudhary, S. Sharma, R. Sharma, B. Airan, P. Venugopal, B. Dubey, A. Bhan, S. K. Choudhary, et al. Assessment of Internal Mammary Artery Graft Patency: Angiography or Doppler? Asian Cardiovasc Thorac Ann, December 1, 2000; 8(4): 325 - 329. [Abstract] [Full Text] [PDF]

				S. Gupta, F. Murgatroyd, K Widenka, T.J Spyt, and D.P De Bono Role of transcutaneous ultrasound in evaluation of graft patency following minimally invasive coronary surgery Eur. J. Cardiothorac. Surg., October 1, 1998; 14(suppl_1): S88 - S92. [Abstract] [Full Text] [PDF]

				Y. Yoshida, M. Fujita, Y. Kihara, S. Kubo, T. Tanaka, T. Iwase, S.-i. Tamaki, T. Sato, C.-H. Park, and A. Yamazato Assessment of long-term left internal thoracic artery graft patency by exercise Doppler echocardiography J. Thorac. Cardiovasc. Surg., April 1, 1998; 115(4): 954 - 956. [Full Text] [PDF]