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  • Title: Assessment of internal thoracic artery patency with transesophageal echocardiography during coronary artery bypass graft surgery.
    Author: Kuroda M, Hamada H, Kawamoto M, Orihashi K, Sueda T, Otsuka M, Yuge O.
    Journal: J Cardiothorac Vasc Anesth; 2009 Dec; 23(6):822-7. PubMed ID: 19640742.
    Abstract:
    OBJECTIVE: The purpose of this study was to evaluate intraoperative transesophageal echocardiography (TEE) for assessing patency of internal thoracic artery grafts. DESIGN: A retrospective study. SETTING: A university hospital. PARTICIPANTS: Fifty-one consecutive patients who underwent coronary artery bypass graft (CABG) surgery using the left internal thoracic artery (LITA)-to-left coronary artery were examined postoperatively with coronary angiography (CAG). INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: The authors measured blood flow velocity using TEE after anastomosis of a LITA graft. Intraoperative TEE findings and routine CAG results were compared to evaluate the quality of TEE assessment. The LITA was detected in 45 of 51 patients (88%) intraoperatively with TEE. Peak and mean velocities and velocity time integral ratios were determined by dividing each diastolic value by its corresponding systolic value. The peak velocity ratio was 0.51 +/- 0.04 (range, 0.40-0.59) in the presence of stenosis and 1.14 +/- 0.10 (range, 0.58-3.87) in its absence (p = 0.0289), whereas mean velocity ratios were 0.62 +/- 0.05 (range, 0.45-0.72) and 1.27 +/- 0.10 (range, 0.66-4.08) (p = 0.0223), respectively, and velocity time integral ratios were 0.83 +/- 0.09 (range, 0.64-1.05) and 2.69 +/- 0.29 (range, 0.91-8.35) (p = 0.0224), respectively. The critical values for peak and mean velocities and velocity time integral ratios were 0.60, 0.73, and 1.06, respectively, whereas the sensitivity for each was 100% and the specificity was 92%, 94%, and 89%, respectively. CONCLUSIONS: The authors concluded that the intraoperative assessment of LITA patency with TEE was a markedly useful and powerful tool for anesthesiologists during CABG surgery.
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