HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Olivier Jegaden Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jegaden, O. Articles by Mikaeloff, P. Search for Related Content PubMed PubMed Citation Articles by Jegaden, O. Articles by Mikaeloff, P.

Eur J Cardiothorac Surg 1999;16:131-134
© 1999 Elsevier Science NL

Two-year assessment by exercise Thallium scintigraphy of myocardial revascularization using bilateral internal mammary and gastroepiploic arteries

^a Department of Cardio-vascular Surgery, Cardiovascular hospital, Cl Bernard University,Lyon, France
^b Department of Nuclear Medecine, Cardiovascular hospital, Cl Bernard University, Lyon, France
^c Department of Cardiology, Cardiovascular hospital, Cl Bernard University, BP Lyon-Monchat, 69394 Lyon cedex 03, France

Corresponding author. Tel.: +33-472357530; fax: +33-472357532
e-mail: ojegaden{at}compuserve.com,

Objective: To assess the blood flow supply offered to the myocardium by surgical revascularization using bilateral internal mammary (IMAs) and gastroepiploic (GEA) arteries. Methods: Two-year assessment by exercise thallium myocardial scintigraphy without medical treatment was performed in 122 patients (mean age 61±9 years) who underwent coronary artery bypass grafting (CABG) with exclusive use of IMAs and GEA. Usually, the right IMA was used to bypass the left anterior descending coronary artery, and the left IMA to bypass the diagonal and the marginal arteries as a sequential graft if required. The GEA was used to bypass the right coronary artery (RCA) in 50 patients and its posterior branches in 72 patients. Results: During maximal or submaximal exercise stress testing, 119 patients (98%) were asymptomatic and 26 patients (21%) exhibited moderate ischemic ECG modifications which were correlated (P<0.01) with incomplete revascularization and with the use of GEA to bypass the RCA. A third of patients had moderate ischemic thallium defects on exercise reversible after redistribution (anterior, 10; lateral, 2; inferior, 28). Silent residual myocardial ischemia detected by thallium scintigraphy was correlated (P<0.001) with ECG modifications and incomplete revascularization; and inferior thallium defects were more frequent when GEA bypassed the RCA (P<0.05). However, 26% of patients had residual ischemia despite a complete revascularization, and in at least 18% of cases for GEA and 8% for right IMA, arterial graft blood flow was insufficient at maximum exercise level and caused silent residual myocardial ischemia detected by thallium scintigraphy. Conclusions: Myocardial revascularization using bilateral IMAs and GEA offers a satisfactory myocardial perfusion in the majority of cases; however silent residual myocardial ischemia was detected in a third of patients and was related to incomplete revascularization and to insufficient blood flow supply probably due to small diameter of the arterial grafts.

Key Words: Coronary artery bypass grafting • Arterial grafts • Gastroepiploic arteries • SPECT