Eur J Cardiothorac Surg 2000;17:190-191
© 2000 Elsevier Science NL
Preoperative checking of IMA(s): to do or not to do?
Evgenii V. Kolesov
Dnepropetrovsk State University, Dnepropetrovsk, Ukraine
1/58, Furmanova Street, 49005 Dnepropetrovsk, Ukraine. Tel./fax: +38-056-744-5051
e-mail: kolesovmd{at}hotmail.com
The paper by Gaudino et al. [1] regarding the influence of side-branches on steal of flow in IMA(s) attracted my attention for several reasons. Firstly the discussed question could straightly influence on surgical performance. In distinct cases the necessary length of IMA grafts could be achieved without its complete upward dissection. This could really contribute to the concept of MIDCABG. In the clinic of Professor V.I. Kolesov in St. Petersburg pioneered MIDCABG in 60–70th preparation of IMA(s) up for ‘3–4 intercostal spaces’ [2] (p. 197) was accepted as one for gentle IMA management and was opposed to it formal complete dissection. With such approach 20–22 years patency of IMA-grafts was shown angiographically [3]. Quite in accordance with Gaudino et al. [1] in case of failure of the anastomosis huge development of side branches was seen both in experimental and clinical cases [2] (p. 247).
One principal consideration looks of utmost importance. There is no generally accepted protocol of IMA assessing before a surgical procedure. In the clinic directed by V.I. Kolesov a method of hemiselective mammariography was installed [4]. It consisted in dye injection in the subclavian artery with the same catheter which was used for right coronarography. The method proved to be fast, with low trauma and highly informative (Fig. 1). Many times in modern clinics I was disappointed due to lack of anatomical information of potential IMA grafts, of ‘that particular anatomic variations’ [1] which are so necessary for serious planning MIDCABG procedures. Bringing details of the graft quality including it length, diameters and branches such studies could serve very important role in revascularization strategy as well as in the decision to cure or not to cure IMA branches.
Doppler assessing of IMA(s) avowed by Gaudino et al. [1] and (hemiselective) mammariography must become protocol parts in preoperative study of a coronary patient.
References
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Gaudino M., Serricchio M., Tondi P., Glieca F., Bruno P., Possati G., Pola P. Do internal mammary artery side-branches have the potential for haemodynamically significant flow steal?. Eur J Cardio-thorac Surg 1999;15:251-254.[Abstract/Free Full Text]
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Kolesov VI. The surgery of coronary arteries of the heart. Leningrad: Meditsina Publishers, 1977.
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Kolesov V.I., Kolesov E.V. Twenty years results with internal thoracic artery – coronary artery anastomosis. J Thorac Cardiovasc Surg 1991;101(2):360-361.
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Astafieva SD. Angiographic studies of the patients with IHD before and after surgical treatment. Autoreferat of the dissertation. Leningrad, 1978.
Received November 23, 1999;
accepted December 21, 1999.
Related Article
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Reply to E.V. Kolesov
- Mario Gaudino, Michele Serricchio, and Gianfederico Possati
Eur. J. Cardiothorac. Surg. 2000 17: 192.
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