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Eur J Cardiothorac Surg 2000;17:192
© 2000 Elsevier Science NL

Letter to the Editor

Reply to E.V. Kolesov

Mario Gaudino, Michele Serricchio, Gianfederico Possati

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

Corresponding author. Tel./fax: +39-6-305-5535
e-mail: mgaudino{at}pelagus.it

Modern coronary artery surgery is based, at least in part, on the pioneering work of Professor V.I. Kolesov and colleagues in the early 1970s [1] and, for this reason, we were particularly pleased by the interest of Dr E.V. Kolesov to our recent paper [2].

In recent years our group has devoted a considerable amount of investigative efforts to clarify the potential of internal mammary artery side-branches (IMASB) to produce an hemodynamically or clinically significant degree of flow steal and, after extensive experimental and clinical investigation, it seems now quite evident that IMASB have limited flow capacity in almost all physiological conditions and can be responsible for evident flow steal only in case of experimental selective muscular vasodilatation or anastomotic failure [2–5].

So, even in this regard, the pioneering ideas proposed by Professor Kolesov more than 20 years ago have now found scientific demonstration of correctness.

Although our transthoracic echo-Doppler studies of the IMA were not aimed at evaluating the usability of the conduit for coronary artery bypass procedures, we agree with Dr Kolesov that this method can provide important information about IMA size, length and flow, excluding for instance the presence of a significant subclavian stenosis (an entity who has the potential to jeopardize a technically successful bypass operation and whose exact incidence in the cardiac surgery population is poorly known).

When compared to selective mammography the echo-Doppler method can be more convenient as it avoids a further increase in cath-lab time (more and more important in this cost-containing era) and an ulterior administration of contrast medium (who can precipitate a previously reduced renal function). Moreover, as the IMA has a superficial and favourable anatomical position the exam usually requires only few minutes and can be performed even by less experienced operators. However, to objectively assess the advantages of preoperative IMA evaluation (either angiographic or echographic) and to correctly evaluate its economic impact, large prospective randomized trials including patients with and without preoperative IMA study should be carried out, preferably by different institutions.

References

  1. Kolesov V.I., Kolesov E.V. Twenty year results with internal thoracic artery – coronary artery anastomosis. J Thorac Cardiovasc Surg 1991;101:360-361.
  2. Gaudino M., Serricchio M., Tondi P., Glieca F., Bruno P., Possati G., Pola P. Do internal mammary artery side-branches have the potential for hemodynamically significant flow steal?. Eur J Cardio-thorac Surg 1999;15:251-254.[Abstract/Free Full Text]
  3. Gaudino M., Serricchio M., Tondi P., Glieca F., Giordano A., Trani C., Pola P., Possati G. Non-invasive evaluation of mammary artery flow reserve and adequacy to increased myocardial oxygen demand. Eur J Cardio-thorac Surg 1998;13:404-409.[Abstract/Free Full Text]
  4. Gaudino M., Serricchio M., Glieca F., Bruno P., Tondi P., Giordano A., Trani C., Calcagni M.L., Pola P., Possati G. Steal phenomenon from mammary side-branches: when does it occur?. Ann Thorac Surg 1998;66:2056-2062.[Abstract/Free Full Text]
  5. Pragliola C., Gaudino M., Bombardieri G., Barilaro C., Bruno P., Varano C., Santoro T., Possati G. Patent side branches do not affect coronary blood flow in internal thoracic artery-left anterior descending anastomosis: an experimental study. J Thorac Cardiovasc Surg 1999;118:66-70.[Abstract/Free Full Text]
Received December 14, 1999; accepted December 21, 1999.


Related Article

Preoperative checking of IMA(s): to do or not to do?
Evgenii V. Kolesov
Eur. J. Cardiothorac. Surg. 2000 17: 190-191. [Extract] [Full Text] [PDF]




This Article
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