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(Circulation. 2001;104:373.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Noninvasive Postoperative Angiography for Internal Mammary Artery Grafts

Yoshihiro Sawamura, MD; Kei Takase, MD; Haruo Saito, MD; Sekinori Kikuchi, MD; Takashi Ito, MD

From the Departments of Cardiovascular Surgery (Y.S., S.K., T.I.) and Diagnostic Radiology (K.T.), Ishinomaki Red Cross Hospital, Miyagi, Japan; and the Department of Radiology (H.S.), Tohoku University, Sendai, Japan.

Reprint requests to Dr Sawamura, Department of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan. E-mail ysawa{at}mail.cc.tohoku.ac.jp

Recently, noninvasive imaging modalities such as electron-beam computed tomography, magnetic resonance angiography, and single-slice helical computed tomography (CT) have emerged as ways to visualize the coronary arteries. With regard to internal mammary artery grafts, however, conventional 3D imaging techniques have failed to demonstrate consistently satisfactory performance. We overcame these limitations by using a novel, multislice, helical CT scanner with 4 detector rows (Aquilion, Toshiba Medical Company). For 3D reconstruction and visualization of the coronary arteries, the volume-rendering technique was used.

Our first case was of a 71-year-old woman who had undergone 3-vessel coronary artery bypass graft surgery in 1999. At the time of her bypass operation, the left internal mammary artery (LIMA) was used to graft the first diagonal branch of the left anterior descending coronary artery (LAD). Separate saphenous vein grafts were placed at the LAD and the left circumflex coronary artery. The day before the scheduled catheterization procedure, a trial was undertaken to detect the coronary artery bypass grafts and to image the coronary arteries noninvasively with CT. Three-dimensional images were processed using an independent workstation system (Zio M900, AMIN).

Figure 1 shows the volume-rendered images that were generated from a 3D image data set with 1.25-mm sections and 0.5-mm phase increments. End-diastolic images free of motion artifacts were reconstructed by absolute-reverse ECG gating. The LIMA bypass graft was clearly identified. A free saphenous vein graft placed at the left circumflex coronary artery was totally occluded at the proximal anastomosis. Another saphenous vein graft placed at the LAD was clearly detected by intravenous enhanced CT angiography. The patency of these grafts was confirmed by conventional coronary angiography (Figure 2). Three-dimensional reconstruction using the volume-rendering technique demonstrated good image quality, permitting the morphology and patency of the graft to be evaluated.

View larger version (132K): [in this window] [in a new window]   Figure 1. Volume-rendering 3D reconstruction image of a 71-year-old woman who had undergone 3-vessel coronary artery bypass graft surgery. At the time of her bypass operation, the LIMA was used to graft the first diagonal branch of the LAD. Separate saphenous vein grafts were placed at the LAD and the left circumflex coronary artery. This image was acquired in the left anterior oblique view at 30 degrees. The LIMA descends along the ascending aorta and then changes its course at almost a right angle toward the first diagonal branch. The course matches the angiographic findings, although the distal anastomosis is not visualized. A localizing marker is displayed on the ascending aorta to indicate the proximal anastomoses of the free saphenous vein grafts. One of the 2 saphenous vein grafts is totally occluded at the origin. The other is anastomosed to the main stem of the LAD, and the distal anastomosis is clearly visualized. Calcification is observed along the entire length of the right coronary artery.

View larger version (54K): [in this window] [in a new window]   Figure 2. A, Conventional coronary angiography confirmed the patency of the left internal mammary artery bypass graft placed at the first diagonal branch of the LAD. B, Conventional coronary angiography confirmed the patency of the free saphenous vein graft placed at the left anterior descending coronary artery. The free saphenous vein graft placed at the left circumflex artery was totally occluded (not shown).

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MCI-267, Houston, TX 77030.

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sawamura, Y. Articles by Ito, T. Search for Related Content PubMed PubMed Citation Articles by Sawamura, Y. Articles by Ito, T. Related Collections CT and MRI