左胸廓内动脉转流术后远期通畅性的超声与冠状动脉造影对照研究

Assessment of the left thoracic artery graft late postoperative patency by ultrasound contrast with angiography

目的应用冠状动脉血流显像技术结合外周血管超声评价左胸廓内动脉转流术后远期桥血管通畅性。与冠状动脉造影对照，探求评价吻合口通畅性的可靠的桥血管血流参数。方法对冠状动脉搭桥术后1年以上行冠状动脉造影术随访的46例患者行超声检查。探测左胸廓内动脉桥血管及左前降支，测量各段收缩期及舒张期峰值流速及流速时间积分，并计算舒张期与收缩期峰值流速比和舒张期流速时间积分分数。根据造影结果分组。结果31例患者左胸廓内动脉桥血管通畅，11例患者桥血管功能不良，4例患者桥血管闭塞。桥血管通畅组与桥血管功能不良组进行比较，桥血管起始段血流动力学参数差异有统计学意义，通畅组舒张期与收缩期峰值流速比及舒张期流速时间积分分数大于功能不良组。远端左前降支舒张期峰值流速通畅组大于功能不良组。结论超声可显示桥血管血流信号，提供评价桥血管通畅性的依据，是术后随访的一种有效方法。

Objective To access the left internal thoracic artery （LITA） graft late postoperative patency after coronary artery bypass grafting （CABG） by peripheral blood vessel ultrasound combined with color Doppler coronary flow imaging （CDCFI）. In contrast with angiography, try to find available flow parameter to access graft patency. Methods Forty-six patients with CABG more than 1 year postoperatively followed-by angiography were detected by ultrasound. The LITA graft and left anterior descending artery were examined. Systolic and diastolic peak velocity （Smax, Dmax）, velocity time integral （VTIs, VTId） of each segment were measured separately. The ratio of diastolic and systolic peak velocity （D/S）, and diastolic velocity time integral fraction（DVTIF） were calculated. All patients were divided into groups according to angiography results. Results Thirty one LITA grafts were patent,ll were dysfunctional,4 were occlusive. According to the angiography results, the flow parameters of the proximal segment of LITA graft were significant. The D/S and DVTIF of patent group was higher than that of dysfunctional group. The diastolic peak velocity of distal segment of LAD of patent group was higher than that of dysfunctional group. Conclusions Peripheral blood vessel ultrasound combined with CDCFI could provide the evidence to access the patency of the graft. It was an effective method for the clinical follow-up.