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Eur J Cardiothorac Surg 2001;19:254-259
© 2001 Elsevier Science NL

Vasoactive response of different parts of human internal thoracic artery to isosorbide-dinitrate and nitroglycerin: an in-vitro study

^a Department of Thoracic and Cardiovascular Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel-Aviv 64239, Israel
^b The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel

Received 27 June 2000; received in revised form 18 December 2000; accepted 8 January 2001.

Corresponding author. Tel.: +972-3-697-3322; fax: +972-3-697-4439
e-mail: shapiraiz{at}tasmc.health.gov.il

Objective: The left internal thoracic artery (LITA) is the most important graft for coronary artery bypass grafting (CABG). Its distal region is, however, prone to vasospasm. The effect of nitroglycerin (NTG) and isosorbide-dinitrate (ISDN) on different segments of this region was studied. Methods: Rings of three segments of the LITA were studied: 6–9 mm proximal to the bifurcation (part A); 1–3 mm proximal to the bifurcation (part B); and 3–6 mm distal to the bifurcation (part C). After baseline, maximal contraction of the rings was achieved using 60 mmol/l of KCl, they were exposed to increasing doses of ISDN and NTG (10–100 µg/ml), and dose–response curves were recorded. Results: The contractile response of part A to KCl was significantly lower than that of parts B and C (1.87±0.25 versus 4.05±0.39 and 7.64±0.54 g, respectively; P<0.001). Both nitrates inhibited the contractile response in a concentration-dependent manner. The relaxing effects of both nitrates on part A was most pronounced (P<0.01), with the effect of ISDN being higher than that of NTG (P<0.01). Conclusions: The region 6–9 mm proximal to the LITA bifurcation is less prone to vasospasm, and has greater relaxation responses to ISDN and NTG than the more vasospastic distal parts of the LITA. We recommend avoiding the use of the very distal part of this artery during CABG, and to use high doses of ISDN rather than NTG as an anti-spastic measure.

Key Words: Human internal thoracic artery • Nitroglycerin • Isosorbide-dinitrate

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