Document Detail


Failed coronary artery bypass anastomosis detected by intraoperative coronary flow measurement.
MedLine Citation:
PMID:  9814798     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To assess intraoperative flow of arterial and venous coronary grafts after myocardial revascularization which may allow early detection of low flow situations, especially during minimally invasive coronary bypass surgery (MIDCAB), and lead to immediate correction of technical problems. METHODS: In two patients with severe and diffuse multi-vessel disease the left internal mammary artery (IMA) was connected to the left anterior descending artery (LAD). During reperfusion, the flow was measured in the IMA and vein grafts using a transit time flow meter. RESULTS: In both cases the IMA showed only a systolic pendulating flow curve with a mean flow of 0-1 ml/min and a high resistance. Manual IMA assessment revealed an adequate pulsation. Both distal IMA anastomoses were re-explored on cardiopulmonary bypass yielding an initial flow of 7 and 14 ml/min, respectively. After treatment with papaverine/adenosine the IMA flow increased from 7 to 26 ml/min (coronary flow reserve (CFR) = 3.7) and from 14 to 46 ml/min (CFR = 3.3), respectively. CONCLUSION: Intraoperative flow assessment of IMA and venous bypass grafts can be recommended to monitor flow; especially during MIDCAB procedures.
Authors:
B H Walpoth; A Bosshard; B Kipfer; P A Berdat; U Althaus; T Carrel
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  14 Suppl 1     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  1998 Oct 
Date Detail:
Created Date:  1999-01-19     Completed Date:  1999-01-19     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  NETHERLANDS    
Other Details:
Languages:  eng     Pagination:  S76-81     Citation Subset:  IM    
Affiliation:
Clinic for Thoracic and Cardiovascular Surgery, University of Berne, Switzerland. beat.walpoth@insel.ch
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Flow Velocity / drug effects,  physiology
Coronary Circulation / drug effects,  physiology*
Coronary Disease / physiopathology,  surgery*
Epinephrine / pharmacology
Extracorporeal Circulation
Female
Humans
Internal Mammary-Coronary Artery Anastomosis*
Intraoperative Care
Intraoperative Complications / diagnosis
Male
Middle Aged
Papaverine / pharmacology
Surgical Procedures, Minimally Invasive
Treatment Failure
Chemical
Reg. No./Substance:
51-43-4/Epinephrine; 58-74-2/Papaverine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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