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Ann Thorac Surg 2004;77:2221
© 2004 The Society of Thoracic Surgeons

Images in cardiothoracic surgery

Stenosed mammary artery graft depicted by multidetector computed tomography

Min-Ho Song, MD*a, Makihiro Ishida, BSb, Takashi Iyoda, BSb, Hideki Goto, BSb

a Cardiovascular Surgery, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Shizuoka-shi, Shizuoka 422-8527, Japan
b Radiology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan

* Address reprint requests to Dr Song, The Japanese Red Cross Nagoya First Hospital, Department of Cardiovascular Surgery, 3-35 Michisita-cho, Nakamura-ku, Nagoya, Aichi 453-8511, Japan
e-mail: songmhmd{at}yahoo.co.jp

The latest generation of multidetector computed tomography (MDCT) enables us to see the anastomotic status of coronary grafts in about 10 minutes by one intravenous injection of contrast medium. The newest facility was installed at our hospital and was applied to depiction of postoperative stenosis of right internal mammary artery graft. The machine is 4-row LightSpeed Plus (GE Medical Systems, Milwaukee, WI).

This patient had redo coronary artery bypass grafting using right internal mammary artery to occluded previous saphenous vein graft anastomosed left anterior descending artery. His left internal mammary artery was too small to be used as a graft. After completion and recovery of this off-pump surgical procedure MDCT was undertaken and it showed 90% stenosed right internal mammary artery at anastomosis (Fig 1, arrow). Coronary angiogram was done to intervene this anastomotic stenosis and it showed the same stenosis (Fig 2, arrow). The lesion was stented and the patient became angina-free since then.



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  		Fig 1.
 


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  		Fig 2.
 
The sensitivity and specificity was not yet fully established regarding capacity of MDCT coronary imaging but Treede and colleagues recently reported that sensitivity was 92%, specificity was 84%, and negative predicted value was 89% for significant stenosis compared with usual coronary angiogram [1]. Kopp and colleagues concluded in 102 patients studied that high resolution MDCT permits the noninvasive detection of coronary artery stenoses with high accuracy [2]. The MDCT imaging of this case was very encouraging as an alternative for angiogram. Cardiac synchronous software, CardioIQ (GE Medical Systems), has been equipped with MDCT and is capable of verifying graft status without the use of heart rate control medication. We are now practicing postoperative MDCT as a routine follow-up after coronary artery bypass grafting surgery.

References

  1. Treede H., Becker C., Reichenspurner H., Knez A., Detter C., Reiser M., et al. Multidetector computed tomography (MDCT) in coronary surgery: first experiences with a new tool for diagnosis of coronary artery disease. Ann Thorac Surg 2002;74:S1398-1402.[Abstract/Free Full Text]
  2. Kopp A.F., Schroeder S., Kuettner A., Baumbach A., Georg C., Kuzo R., et al. Non-invasive coronary angiography with high resolution multidetector-row computed tomography. Results in 102 patients. Eur Heart J Text 2002;23:1714-1725.[Abstract/Free Full Text]



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M.-H. Song, T. Ito, T. Watanabe, and H. Nakamura
Multidetector Computed Tomography Versus Coronary Angiogram in Evaluation of Coronary Artery Bypass Grafts
Ann. Thorac. Surg., February 1, 2005; 79(2): 585 - 588.
[Abstract] [Full Text] [PDF]

This Article
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