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Eur J Cardiothorac Surg 2005;27:726-727
© 2005 Elsevier Science NL

Letter to the Editor

Reply to Barner

Department of thoracic and Cardiovascular Surgery, Kanazawa Medical University, Ishikawa, Japan

Received 4 January 2005; accepted 4 January 2005.

^* Address: 1-1, Daigaku, Uchinada, Kahokugun, 920-0265, Japan. Tel.: +81 076 286 2211; fax: +81 076 286 2322. (E-mail: katsu-i{at}kanazawa-med.ac.jp).

Key Words: Internal thoracic artery • Phosphodiesterase III inhibitor • Papaverine hydrochloride

We appreciate the interest of Dr Barner in our article on the reactivity of the human internal thoracic artery to vasodilators in coronary artery bypass grafting (CABG) [1].

We know that maximal vasodilation to papaverine hydrochloride requires at least 10min of exposure [2]. And we know that maximal mean response to PDEIII inhibitor requires at 15min [3].

In fact, before this study we too used papaverine hydrochloride in performing CABG. We were also aware of the differing reaction times of the other vasodilators which we used and considered these reactions times under fixed conditions.

Within clinical study conditions the importance of papaverine hydrochloride has been noted, but in conjunction with PDEIII inhibitor reaction time PDEIII inhibitor is the better of the two in actual practice. Liu and associates showed that comparison of PDEIII inhibitor with other vasodilators, including papaverine hydrochloride, nitroprusside, and glyceryl trinitrate, showed PDEIII inhibitor to be more potent of vasodilation than papaverine hydrochloride but less potent than nitroprusside and glyceryl trinitrate [4].

Now, when performing CABG it is our preference to use the PDEIII inhibitor as opposed to papaverine hydrochloride. PDEIII inhibitor reaction time under operating conditions exhibits more responsive and effective results with regard to maximal vasodilation and increased free flow of blood within the optimal for one minute.

References

1. Takeuchi K, Sakamoto S, Nagayoshi Y, Nishizawa H, Matsubara J. Reactivity of the human internal thoracic artery to vasodilators in coronary artery bypass grafting. Eur J Cardiothorac Surg 2004(26):956-959.
2. He G-W, Yang C-Q. Use of verapamil and nitroglycerin solution in preparation of radial artery for coronary grafting. Ann Thorac Surg 1996;61:610-614.[Abstract/Free Full Text]
3. Anderson JL, Baim DS, Fein SA, Goldstein RA, LeJemtel TH, Likoff MJ. Efficacy and safety of sustained (48hour) intravenous infusions of milrinone in patients with severe congestive heart failure: a multicenter study. J Am Coll Cardiol 1987(9):711-722.
4. Liu JJ, Doolan LA, Xie B, Chen JR, Buxton BF. Direct vasodilator effect of milrinone, an inotropic drug, on arterial coronary bypass grafts. Ann Thorac Surg 1987(44):108-113.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Takeuchi, K. Search for Related Content PubMed Articles by Takeuchi, K. Related Collections Cardiac - pharmacology Cardiac - physiology