Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Determination of Early Graft Patency Using CT Angiography after Coronary Artery Bypass Surgery

관상동맥우회술 후 CT 조영술을 이용한 이식편의 조기 열림의 판정

  • 이미경 (원광대학교 의과대학 흉부외과학교실) ;
  • 류대웅 (원광대학교 의과대학 흉부외과학교) ;
  • 최순호 (원광대학교 의과대학 흉부외과학교) ;
  • 최종범 (원광대학교 의과대학 흉부외과학교실)
  • Published : 2004.07.01
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Abstract

CT angiography is now available to evaluate the early graft patency after coronary bypass surgery. We investigated whether patency or occlusion of the bypass grafts can be visualized by CT angiography and what factors effect the visuality. Material and Method: Fifty patients underwent scanning with a 4-slice computed tomographic scanner (Somatom Volume ZoomTM; Siemens, Germany) before being discharged after coronary artery bypass grafting. To evaluate graft patency and relationship between the quality of graft image and the characteristics of the diseased coronary vessels, 50 internal thoracic artery grafts, 18 radial artery grafts, and 56 vein grafts were included in this study. Result: All vein grafts (24 grafts; 32 anastomoses) to left coronary artery system were well visualized, but 3 grafts (4.7%) of 30 vein grafts (35 anastomoses) to right coronary artery system were not visualized. The latter was also occluded in invasive coronary angiographic study. Thirty-nine (78%) internal thoracic artery grafts were well visualized, 8 (16%) faintly visualized, and 3 (6%) not visualized, but all the internal artery grafts were well patent in invasive coronary angiographic study. Conclusion: Unvisualized vein grafts in CT angiography means occlusion of the grafts, but unvisualized arterial grafts in CT angiography may not mean occlusion of the graft but result from competitive flow between the graft and coronary artery. To confirm patency of the unvisualized arterial grafts, invasive coronary angiography is needed.

관상동맥우회술 후 이식편의 조기 열림을 판정하기 위한 CT 조영술은 비침습적이고 간단하며 안전한 방법으로 알려져 있다. 저자들은 관상동백 우회술 환자들에서 수술 후 퇴원 전에 CT 조영술을 시행하여 이식편의 조기 열림의 판정에 대한 여부와 영상에 미치는 인자들을 조사하였다. 대상 및 방법: 관상동맥 우회술을 받은 50예에서 수술 후 퇴원 전에 4개의 검출기를 가진 CT기로 조영술을 시행하고 내흉동맥 이식편(50편), 요골동맥편(18편), 대퇴정맥편(56편)의 조영상해로 이식편의 열림을 조사하고 이식편의 조영상태와 문합혈관의 직경, 부행혈류 및 협착정도와의 관계를 분석하였다. 결과: 좌관상동맥계에 문합되는 정맥편(24편, 32문합부)은 모두 잘 조영되었으나, 우관상동백계에 문합된 정맥편(30편, 35문합부) 중 3편 (4.7%)은 CT 조영술에서 조영되지 않았고 대퇴동맥을 통한 침습적인 관상동맥 조영술에서도 폐쇄된 소견을 보였다. 내흉동맥편 중 39편(78%)은 CT 조영술에서 잘 조영되었고 8편(16%)은 일부 좁아지거나 끊기는 불완전한 조영을 보였으며 3편(6%)은 조영되지 않았으나 동맥을 통한 침습적인 관상동맥 조영술에서는 모두 정상적인 열림 소견을 보였다. 결론: 관상동맥조영술 후 CT 조영술에서 조영되지 않는 정맥편은 페쇄를 의미하나, CT조영술에서 조영되지 않는 동맥편은 폐쇄가 아닌 관상동맥과 이식편 사이의 상경혈류 때문에 일어날 수 있으므로 조영이 안 되는 동맥편의 열림을 확인하기 위해서는 침습적인 관상동맥조영술이 필요할 것으로 생각된다.

Keywords

References

  1. Cathet Cardiovasc Diagn v.8 Complications associated with cardiac catheterization and angiography Kennedy,J.W. https://doi.org/10.1002/ccd.1810080103
  2. Circulation v.61 Detection of patent coronary bypass grafts by computed tomography. A preliminary report Brundage,B.H.;Lipton,M.J.;Herfkens,R.J.(et al.) https://doi.org/10.1161/01.CIR.61.4.826
  3. Am J Roentgenol v.168 Contrast-enhanced breath-hold MR angiography for evaluating patency of coronary artery bypass grafts Vrachliotis,T.G.;Bis,K.G.;Aliabadi,D.;Shetty,A.N.;Safian,R.;Simonetti,O. https://doi.org/10.2214/ajr.168.4.9124118
  4. Lancet v.357 Coronary angiography with multi-slice computed tomography Nieman,K.;Oudkerk,M.;Rensing,B.J.(et al.) https://doi.org/10.1016/S0140-6736(00)04058-7
  5. Am J Cardiol v.79 Noninvasive, three-dimensional visualization of coronary artery bypass grafts by electron beam tomography Achenbach,S.;Moshage,W.;Ropers,D.;Nossen,J.;Bachmann,K. https://doi.org/10.1016/S0002-9149(97)00003-9
  6. Yonsei Med J v.44 Assessment of coronary artery bypass graft patency by multislice computed tomography Ko,Y.G.;Choi,D.H.;Jang,Y.S.(et al.) https://doi.org/10.3349/ymj.2003.44.3.438
  7. Heart v.84 Non-invasive coronary artery imaging with electron beam computed tomography and magnetic resonance imaging de Feyter,P.J.;Nieman,K.;van Ooijen,P.;Oudkerk,M. https://doi.org/10.1136/heart.84.4.442
  8. Int J Cardiol v.90 Non-invasive evaluation of coronary artery bypass grafts using multi-slice computed tomography: initial clinical experience Burgstahler,C.;Kuettner,A.;Kopp,A.F.(et al.) https://doi.org/10.1016/S0167-5273(02)00569-7
  9. Eur J Cardiothorac Surg v.24 The comparison of the graft patency after coronary artery bypass grafting using coronary angiography and multi-slice computed tomography Yoo,K.J.;Choi,D.;Choi,B.W.;Lim,S.H.;Chang,B.C. https://doi.org/10.1016/S1010-7940(03)00192-1
  10. Clin Imaging v.26 Influence of heart rate on vessel visibility in noninvasive coronary angiography using new multislice computed tomography: experience in 94 patients Schroeder,S.;Kopp,A.F.;Kuettner,A.(et al.) https://doi.org/10.1016/S0899-7071(01)00371-0
  11. Am J Roentgenol v.179 Nonivasive visualizaiton of coronary arteries using contrast-enhanced multidetector CT: influence of heart rate on image quality and stenosis detection Giesler,T.;Baum,U.;Ropers,D.(et al.) https://doi.org/10.2214/ajr.179.4.1790911
  12. Circulation v.103 Detection of coronary artery stenoses by contrast-enhanced, retrospectively electrocardiographically-gated, multislice spiral computed tomography Achenbach,S.;Giesler,T.;Ropers,D.(et al.) https://doi.org/10.1161/01.CIR.103.21.2535
  13. Circulation v.107 Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction Ropers,D.;Baum,U.;Pohle,K.(et al.) https://doi.org/10.1161/01.CIR.0000055738.31551.A9
  14. Ann Thorac Surg v.76 Noninvasive evaluation of arterial grafts with newly released multi-detector computed tomography Gurevitch,J.;Gaspar,T.;Orlov,B.(et al.) https://doi.org/10.1016/S0003-4975(03)00955-X