经胸多普勒超声心动图评价左乳内动脉桥血管通畅性的研究

ASSESSMENT OF LEFT INTERNAL MAMMARY ARTERY GRAFT PATENCY USING TRANSTHORACIC DOPPLER ECHOCARDIOGRAPHY

目的用经胸多普勒超声心动图（transthoracic Doppler echocardiography,TDE）检查左乳内动脉（left internal mammary artery,LIMA）桥-左前降支吻合口处血流,探讨TDE评价LIMA桥血管通畅性的应用价值。方法选择LIMA桥原位转流术后行冠状动脉造影随访患者39例,探查LIMA桥吻合口处,于桥血管、吻合口及吻合口远端1~2cm范围内自体左前降支取样,测量收缩期峰值流速、舒张期峰值流速、收缩期速度时间积分、舒张期速度时间积分,并计算舒张期与收缩期峰值流速比值、舒张期速度时间积分分数。将结果与造影对照。结果32例（82.1%）吻合口超声图像能够显示,1例显示桥近吻合口处有血流回声中断,余31例患者3处测量值无显著性差异。与造影对照TDE检查LIMA桥通畅的准确率为87.2%（34/39）。结论吻合口的TDE显像为LIMA桥是否存在狭窄提供了直接证据。

Objective To evaluate the value of transthoracic Doppler echocardiography （TDE） on assessing the patency of left internal mammary artery（LIMA） graft by detecting its flow characteristics on anstomosis location. Methods Sequential 39 patients were enrolled. Each LIMA graft was detected. The systolic peak velocity,diastolic peak velocity,systolic velocity time integral,diastolic velocity time integral for each segment were measured respectively. The ratio of diastolic peak velocity to systolic peak velocity and diastolic fraction were calculated. Results The echo appearance percentage of the anstomosis was 82.1% （32 patients）. One graft showed uncontinuity of the flow beam. There were no statistically significance among measurements at three segments of the other 31 patients. Compared with coronary angiography, the accuracy of TDE to evaluate internal mammary artery graft patency was 87.2%. Conclusion The appearance of anstomosis of the LIMA graft provides the straight prove for judging the graft＇s patency.