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

This Article 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 Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Carrel, T. Articles by Turina, M. Search for Related Content PubMed PubMed Citation Articles by Carrel, T. Articles by Turina, M.

European Journal of Cardio-Thoracic Surgery, Vol 9, 190-195, Copyright © 1995 by European Association for Cardio-thoracic Surgery

ARTICLES

The internal mammary artery malperfusion syndrome: incidence, treatment and angiographic verification

T Carrel, T Kujawski, G Zund, J Schwitter, FW Amann, A Gallino, O Bertel, R Jenni and M Turina
Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland.

Internal mammary artery (IMA) malperfusion syndrome is caused by an acute imbalance between myocardial demand and nutritional support through the mammary artery. In a consecutive series of 2326 isolated myocardial revascularizations-with at least one IMA to the left anterior descending branch (LAD) in 91.3% (2125/2326)-we identified 45 patients (1.9%) with a perioperative course suggesting IMA malperfusion syndrome. Additional saphenous vein graft to the distal segment of the LAD was performed during normothermic ventricular fibrillation in all patients. Hospital mortality was 4.4% (2/45), intra-aortic balloon pumping was required in 15.5% (7/45) and anterior myocardial infarction occurred in 28.8% (13/45). Coronary angiography was performed in all survivors between 3 and 24 months postoperatively. Wide patent IMA graft and patent saphenous vein graft were observed in 56% (24/43), narrowed but patent IMA graft and patent vein graft in 35% (15/43), while patent vein graft and not visualized IMA in 7% (3/43); in one patient with severely diseased peripheral LAD, no flow could be demonstrated in the IMA graft or in the additional vein graft (1/43, 2.4%). No major differences were found between early and late coronary angiography in these patients. Additional vein graft to distal LAD is the treatment of choice in acute IMA malperfusion syndrome. Despite patent vein graft with superior blood flow, early and late postoperative IMA flow to LAD is maintained in the majority of patients.

This article has been cited by other articles:

				B. H. Walpoth, M. Schmid, A. Schwab, A. Bosshard, F. Eckstein, T. Carrel, and O. M. Hess Vascular adaptation of the internal thoracic artery graft early and late after bypass surgery. J. Thorac. Cardiovasc. Surg., October 1, 2008; 136(4): 876 - 883. [Abstract] [Full Text] [PDF]

				B. Orlov, J. Gurevitch, A. Kogan, V. Rubchevsky, A. Y. Zlotnick, and D. Aravot Multiple Arterial Revascularization Using the Tangential K-Graft Technique Ann. Thorac. Surg., November 1, 2005; 80(5): 1948 - 1950. [Abstract] [Full Text] [PDF]

				B. Rozec, S. Serpillon, G. Toumaniantz, C. Seze, Y. Rautureau, O. Baron, J. Noireaud, and C. Gauthier Characterization of Beta3-Adrenoceptors in Human Internal Mammary Artery and Putative Involvement in Coronary Artery Bypass Management J. Am. Coll. Cardiol., July 19, 2005; 46(2): 351 - 359. [Abstract] [Full Text] [PDF]

				P. Massoudy, Y.-Y. Kim, M. Cetin, M. Thielmann, U. Herold, M. Kamler, and H. Jakob Internal thoracic artery malperfusion: fast decision for an additional vein graft has impact on patient outcome Ann. Thorac. Surg., June 1, 2004; 77(6): 2061 - 2065. [Abstract] [Full Text] [PDF]

				W. E. Harrison, A. J. Mellor, J. Clark, and D. R. J. Singer Vasodilator pre-treatment of human radial arteries; comparison of effects of phenoxybenzamine vs papaverine on norepinephrine-induced contraction in vitro Eur. Heart J., December 1, 2001; 22(23): 2209 - 2216. [Abstract] [PDF]

				A. M. Fabricius, W. Gerber, M. Hanke, J. Garbade, R. Autschbach, and F. W. Mohr Early angiographic control of perioperative ischemia after coronary artery bypass grafting Eur. J. Cardiothorac. Surg., June 1, 2001; 19(6): 853 - 858. [Abstract] [Full Text] [PDF]

				R. Dion, D. Glineur, D. Derouck, R. Verhelst, P. Noirhomme, G. El Khoury, E. Degrave, and C. Hanet Long-term clinical and angiographic follow-up of sequential internal thoracic artery grafting Eur. J. Cardiothorac. Surg., April 1, 2000; 17(4): 407 - 414. [Abstract] [Full Text] [PDF]

				H. Gobel, C. Ihling, J. Dentz, H. E. Schaefer, A. M. Zeiher, and G. Fraedrich Increased tissue endothelin-1-like immunoreactivity in the internal mammary artery of patients with diabetes or hypercholesterolemia modulates the graft flow in the peri-operative period Eur. J. Cardiothorac. Surg., October 1, 1999; 14(4): 367 - 372. [Abstract] [Full Text] [PDF]

				B. H. Walpoth, M. F. Muller, I. Genyk, B. Aeschbacher, B. Kipfer, U. Althaus, and T. P. Carrel Evaluation of coronary bypass flow with color-Doppler and magnetic resonance imaging techniques: comparison with intraoperative flow measurements Eur. J. Cardiothorac. Surg., June 1, 1999; 15(6): 795 - 802. [Abstract] [Full Text] [PDF]

				S. Noda and H. B. Barner Arterial conduits Ann. Thorac. Surg., January 1, 1999; 67(1): 285 - 286. [Full Text] [PDF]

				B. H Walpoth, A. Bosshard, B. Kipfer, P. A Berdat, A. Ueli, and T. Carrel Failed coronary artery bypass anastomosis detected by intraoperative coronary flow measurement Eur. J. Cardiothorac. Surg., October 1, 1998; 14(suppl_1): S76 - S81. [Abstract] [Full Text] [PDF]

				B. H. Walpoth, A. Bosshard, I. Genyk, B. Kipfer, P. A. Berdat, O. M. Hess, U. Althaus, and T. P. Carrel Transit-time flow measurement for detection of early graft failure during myocardial revascularization Ann. Thorac. Surg., September 1, 1998; 66(3): 1097 - 1100. [Abstract] [Full Text] [PDF]

				S. Pagni, E. Salloum, J. Storey, W. Montgomery, P. Cerrito, D. Van Himbergen, L. A. Gray Jr., and P. A. Spence Double grafting of the left anterior descending artery: is the distance between the internal mammary artery and supplemental vein graft anastomoses relevant in graft survival? Eur. J. Cardiothorac. Surg., January 1, 1998; 13(1): 36 - 41. [Abstract] [Full Text] [PDF]

				G. Zund, M. Hauser, P. Vogt, C. P. Davis, M. Lachat, A. Kunzli, M. Genoni, and M. Turina NEW APPROACH TO PATENCY AND FLOW ASSESSMENT AFTER LEFT INTERNAL THORACIC ARTERY HYPOPERFUSION SYNDROME WITH ADDITIONAL SAPHENOUS VEIN GRAFT TO THE LEFT ANTERIOR DESCENDING ARTERY WITH PHASE-CONTRAST MAGNETIC RESONANCE ANGIOGRAPHY J. Thorac. Cardiovasc. Surg., September 1, 1997; 114(3): 428 - 433. [Abstract] [Full Text]

				M. Gaudino, C. Trani, N. Luciani, F. Alessandrini, and G. Possati The Internal Mammary Artery Malperfusion Syndrome: Late Angiographic Verification Ann. Thorac. Surg., May 1, 1997; 63(5): 1257 - 1261. [Abstract] [Full Text]

				T. Carrel, P. Horber, and M. I. Turina Operation for Two-Vessel Coronary Artery Disease: Midterm Results of Bilateral ITA Grafting Versus Unilateral ITA and Saphenous Vein Grafting Ann. Thorac. Surg., November 1, 1996; 62(5): 1289 - 1294. [Abstract] [Full Text]

				M. Kawasuji, N. Sakakibara, H. Takemura, T. Tedoriya, T. Ushijima, and Y. Watanabe IS INTERNAL THORACIC ARTERY GRAFTING SUITABLE FOR A MODERATELY STENOTIC CORONARY ARTERY? J. Thorac. Cardiovasc. Surg., August 1, 1996; 112(2): 253 - 259. [Abstract] [Full Text]

				P. A. Spence, W. D. Montgomery, and W. P. Santamore HIGH FLOW DEMAND ON SMALL ARTERIAL CORONARY BYPASS CONDUITS PROMOTES GRAFT SPASM J. Thorac. Cardiovasc. Surg., October 1, 1995; 110(4): 952 - 962. [Abstract] [Full Text]