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Eur J Cardiothorac Surg 2005;28:662-663
© 2005 Elsevier Science NL

Letter to the Editor

Reply to Motallebzadeh and Wendler

Katsunori Takeuchi *

Department of thoracic and Cardiovascular Surgery, Kanazawa Medical University, Ishikawa, 1-1, Daigaku, Uchinada, Kahokugun, 920-0265, Japan

Received 23 June 2005; accepted 24 June 2005.

* Tel.: +81 076 286 2211; fax: +81 076 286 2322. (Email: katsu-i{at}kanazawa-med.ac.jp).

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

We appreciate the interest that Dr Motallebzadeh and Dr Wendler have expressed about our article on the reactivity of the human internal thoracic artery to vasodilators in coronary artery bypass grafting (CABG) [1]. First, we used pedicled internal thoracic artery (ITA) graft during CABG.

Why did the ITA free flow in our study differ from that of Dr Wendler's? I agree with the indication of Dr Wendler and feel that their result is wonderful [2]. But I think that the indication does not show the whole picture. There may also be influence of the physique. The stump of the left ITA where we measured free flow was distal to the planned anastomotic site to the left anterior descending artery (LAD). We also measured the flow of the left ITA using the flow meter after anastomosis of the LAD. There were no large difference between the preanastomotic free flow and postanastomotic ITA flow.

We know that maximal vasodilation to papaverine hydrochloride requires at least 10min of exposure [3] and that maximal mean response to PDEIII inhibitor requires at least 15min [4]. However, in the PDEIII inhibitor there was a significant increase in left ITA free flow even 1min after injection. We measure the flow 1min after vasodilator injection because we want to eliminate influence of change of circulatory dynamic state, circulation temperature, anesthetic drug and so on. Recently, that off-pump CABG (OPCAB) is increasing in number and vasodilator with faster reactivity is becoming the current trend.

Moreover, I think that PDEIII inhibitor is useful because it has an inotropic action which is not found in papaverine hydrochloride [5].

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.[Abstract/Free Full Text]
  2. Wendler O, Tscholl D, Huang Q, Schafers HJ. Free flow capacity of skeletonized versus pedicled internal thoracic artery grafts in coronary artery bypass grafts. Eur J Cardiothorac Surg 1999;15:247-250.[Abstract/Free Full Text]
  3. 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]
  4. Anderson JL, Baim DS, Fein SA, Goldstein RA, LeJemtel TH, Likoff MJ. Efficacy and safety of sustained (48h) intravenous infusions of milrinone in patients with severe congestive heart failure: a multicenter study. J Am Coll Cardiol 1987;9:711-722.[Abstract]
  5. Konstam MA, Cody RJ. Short-term use of intravenous milrinone for heart failure. Am J Cardiol 1995;75:822-826.[CrossRef][Medline]




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