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Eur J Cardiothorac Surg 1999;15:251-254
© 1999 Elsevier Science NL

Do internal mammary artery side-branches have the potential for haemodynamically significant flow steal?

Department of Cardiac Surgery and Angiology, Catholic University, Rome, Italy

Received 2 June 1998; received in revised form 6 January 1999; accepted 12 January 1999.

Corresponding author. Divisione di Cardiochirurgia, Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy. Tel.: +39-6-3058181; fax: +39-6-3055-535; e-mail: mgaudino@pelagus.it

Objective: To evaluate the potential for flow steal of the internal mammary artery (IMA) side-branches at rest and in case of dilatation of their vascular bed (as probably occurs during physical exercise). Methods: Transthoracic echo-Doppler evaluation of IMA flow was performed preoperatively in 40 patients undergoing myocardial revascularization. IMA flow was measured at rest and in condition of peripheral vasodilatation (obtained using forced ventilation for 2 min, dypiridamole 0.84 mg/kg endovenous (e.v.), xantinole nicotinate 500 mg e.v., nifedipine 20 mg sublingual (s.l.)). Results: IMA mean peak systolic velocity increased 23% after forced ventilation (from 67 to 83 cm/s), 6% after dypiridamole (from 75 to 80 cm/s), 30% after xantinole infusion (from 62 to 81 cm/s) and 23% after nifedipine administration (from 60 to 74 cm/s). IMA flow increased 17.7% after forced ventilation (from 39.5 to 46.5 ml/min), 4.8% after dypiridamole (from 39.2 to 41.1 ml/min), 20.2% after xantinole infusion (from 41.4 to 49.8 ml/min) and 16.5% after nifedipine administration (from 41.6 to 48.5 ml/min). Conclusions: The limited functional flow reserve of the in situ IMA, even after pure muscular vasodilatation, seems to minimize the possibility of significant flow steal from patent IMA graft collaterals.

Key Words: Mammary artery • Collaterals • Flow steal

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