Key result
Intraoperative TEE visualizes PDA grafts in ~95% of cases, identifying early occlusion via low flow.
Why the study?
Intraoperative assessment of coronary artery grafts to the posterior descending artery by transesophageal echocardiography was evaluated for feasibility and diagnostic value.
Does intraoperative transesophageal echocardiography accurately assess coronary bypass graft patency to the posterior descending artery?
Observational (n=21)
Does intraoperative transesophageal echocardiography accurately assess coronary bypass graft patency to the posterior descending artery?
Intraoperative TEE is a feasible method for assessing coronary bypass grafts to the PDA, where a diastolic blood flow velocity <10 cm/s suggests early graft occlusion.
Answers are grounded in this paper and cite their sources.
Supports TEE feasibility for PDA graft assessment; leaves open validation of flow criteria in prospective cohorts.
Intraoperative transesophageal echocardiography (TEE) assessment of coronary artery graft anastomosed to posterior descending artery (PDA) was evaluated. Twenty-one patients with a saphenous vein (SV) graft (n=17) or right gastroepiploic artery (RGEA) graft (n=4) anastomosed to the PDA were examined. In the transgastric mid short-axis view, the graft was depicted as an echo-free zone between the right ventricle and diaphragm. The depth, diameter, angle for Doppler measurement, and angle-corrected blood flow velocity were determined. The graft was visualized in 20 cases (95.2%). The diameter of the SV graft was 3.0-6.5 mm (mean 4.0 mm), while that of RGEA graft was 2.2-2.9 mm (mean 2.5 mm), at the depth of 1.2-4.4 cm (mean 2.4 mm) with incident angle of 14-57 degrees (mean 38.6 degrees ). Blood flow was detected in 17 cases but was difficult to detect in three cases (velocity <10 cm/s). Postoperative coronary angiography showed patent graft in 16 of former cases (one case of operative death excluded) but occluded graft in all of latter cases. Intraoperative TEE assessment was feasible nearly consistently. Diastolic blood flow velocity <10 cm/s suggests an early occlusion of the graft.
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Orihashi et al. (2009) conducted an observational in Coronary artery bypass grafting to the posterior descending artery (n=21). Intraoperative transesophageal echocardiography (TEE) was evaluated on Graft visualization. Intraoperative transesophageal echocardiography successfully visualized coronary grafts to the posterior descending artery in 95.2% of cases, with flow velocity <10 cm/s indicating early occlusion.
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