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Assessment of Internal Mammary Artery Graft Patency: Angiography or Doppler?

Department of Cardiothoracic and Vascular Surgery Cardiothoracic Sciences Centre All India Institute of Medical Sciences New Delhi, India

For reprint information contact: Anil Bhan, MCh Tel: 91 11 686 4851 Fax: 91 11 686 2663 email: anil_bhan{at}hotmail.com Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.

Angiography is the usual means of assessing the patency of grafted internal mammary artery. The feasibility of assessing patency by Doppler echocardiography was studied prospectively in 49 patients undergoing left internal mammary artery-to-left anterior descending coronary artery anastomosis. Postoperative angiographic findings were normal in 45 patients (92%), 2 had > 70% and 2 had < 50% narrowing of either the arterial pedicle or the graft. The left internal mammary artery could be visualized by Doppler echocardiography in 44 patients, 4 of whom had abnormal angiograms; there was an unobstructed flow pattern in 42 patients and an obstructed flow pattern in 2 (completely blocked internal mammary artery in one and > 70% narrowing of the graft in the other). Thallium scanning in patients with suboptimal angiographic results but unobstructed Doppler flow patterns showed no evidence of myocardial ischemia in the left anterior descending artery territory. Echocardiography is a sensitive noninvasive screening modality to diagnose critical narrowing of internal mammary artery grafts. It is suggested that angiography may be reserved for cases in which Doppler echocardiography fails to visualize the internal mammary artery or reveals an abnormal flow pattern.