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Ann Thorac Surg 1999;67:624-628
© 1999 The Society of Thoracic Surgeons
a Department ofCardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
b Department ofCardiology, Catharina Hospital, Eindhoven, the Netherlands
Accepted for publication July 24, 1998.
Address reprint requests to Dr Tavilla, Department of Cardiothoracic Surgery, University Hospital Leiden, K6-S, Postbus 9600, 2300 RC Leiden, the Netherlands
Background. Because the right gastroepiploic artery graft (GEA), when routed antegastrically, is situated just behind the abdominal wall, we investigated the possibility of evaluating graft patency and flow characteristics using transabdominal color Doppler echocardiography.
Methods. The right GEA graft was evaluated in 71 patients who underwent complete arterial revascularization, 4 months (range, 2 to 17 months) postoperatively. Selective angiography of the right GEA was performed in the patients in whom the graft could not be visualized using color Doppler echocardiography.
Results. Flow in the right GEA graft was detected in 65 (91.5%) of 71 patients using color Doppler echocardiography. In all visualized right GEAs, a biphasic flow pattern was observed, with higher peak velocity during systole. Mean (± standard deviation) peak systolic velocity was 76 ± 16 cm/s. Mean (± standard deviation) velocity was 41 ± 14 cm/s. Selective angiography of the right GEA in 5 patients in whom the graft could not be visualized using echocardiography showed four patent and functional grafts and one graft that was open but not functional ("slender sign"). One patient died before angiography could be performed. The sensitivity of noninvasive ultrasound assessment of the patency of the right GEA graft was 94% (65 of 69 patients). In this group of patients, an overall right GEA graft patency rate of 97% (69 of 71 patients) was found at mean follow-up of 4 months (range, 2 to 17 months).
Conclusions. The right GEA graft is an adequate coronary artery graft with a good short-term patency rate, and transcutaneous color Doppler echocardiography is a useful tool for evaluating its patency and flow characteristics. Selective angiography of the right GEA can be avoided in most cases and is indicated only when the graft cannot be detected using Doppler echocardiography.
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