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Eur J Cardiothorac Surg 2007;32:556. doi:10.1016/j.ejcts.2007.06.003
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Letters to the Editor

Reply to Poullis and Warwick

Department of Cardiovascular Medicine and Surgery, University of Louvain Medical School, Brussels, Belgium

Received 31 May 2007; accepted 4 June 2007.

^_* Corresponding author. Address: Service de Chirurgie cardiovasculaire et thoracique, Cliniques Universitaires Saint-Luc–U.C.L.90, Avenue Hippocrate 10/6107, 1200 Bruxelles, Belgium. Tel.: +32 2 7646106; fax: +32 2 7648960 . (Email: david.glineur{at}clin.ucl.ac.be).

Key Words: Coronary artery bypass • Internal mammary artery • Saphenous vein graft • Fractional flow reserve

Dr Poullis [1] wisely raised several points that were not mentioned in our initial manuscript [2].

All the patients who accepted to be enrolled in our study were under statin therapy for secondary prevention. It is true that statin therapy up-regulates endothelium nitric oxide synthase and inhibits inducible nitric oxide synthase. For that reason, we asked all patients to stop statin treatment and all other potentially vaso-active substances at least 48 h before the angiography.

It was suggested that the harvesting technique could play some role in this context. In our study, all mammary arteries were harvested with surrounding tissues (two veins) and were not skeletonized. The difference between right and left mammary arteries observed in our study can thus not be explained by a difference in the harvesting technique.

Finally, it is true that the right mammary artery tends to have a larger diameter than the left artery, mainly on the proximal part near the right sub-clavian artery. However, when dealing with a pedicled artery, because of the length needed to reach the marginal through the transverse sinus and given the progressive tapering of the vessel, the diameter at the site of distal anastomosis is often smaller than that of the shorter left mammary artery graft, even in manual right-handed workers. Differences in diameter between right and left mammary arteries are thus unlikely to be the only factor explaining the difference between both arteries.

References

1. Poullis M, Warwick R. Fractional flow reserve of pedicled left and right internal thoracic arteries. Eur J Cardiothorac Surg 2007;32:555-556.[Free Full Text]
2. Glineur D, Poncelet A, El Khoury G, D’hoore W, Astarci P, Zech F, Noirhomme P, Hanet C. Fractional flow reserve of pedicled internal thoracic artery and saphenous vein grafts 6 months after bypass surgery. Eur J Cardiothorac Surg 2007;31(3):376-381.[Abstract/Free Full Text]

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 Glineur, D. Articles by Hanet, C. Search for Related Content PubMed Articles by Glineur, D. Articles by Hanet, C. Related Collections Coronary disease