Shoichi Furuta

Availability of the in situ right gastroepiploic artery for coronary artery bypass

The right gastroepiploic artery (GEA) has been successfully used as a coronary bypass graft recently. We examined the in situ GEA graft length required from the pyloric portion to the site of coronary anastomosis at the time of operation. Measured GEA length was 17.0 +/- 1.7 cm for the posterior descending artery anastomosis in 17 patients, 17.8 +/- 1.7 cm for the main right coronary artery anastomosis in 13 patients, 22.0 +/- 2.3 cm for the posterolateral branch anastomosis in 7 patients, and 21.0 cm for the left anterior descending artery anastomosis in 1 patient. We examined 228 randomly selected abdominal angiograms and measured the internal diameter of the right GEA at every 2-cm interval from its origin. Probability of availability of the in situ GEA graft for each site of anastomosis was 97% to the right coronary artery and 88% to the anterior descending or the circumflex artery when the internal diameter of GEA was 1.5 mm or greater. From an anatomical standpoint, we concluded that the GEA can be assumed available without preoperative angiography.

Doppler miniprobe to measure arterial graft flow in coronary artery bypass grafting

Using a 5 X 5-mm ultrasonographic Doppler miniprobe, the flow volume of arterial grafts (internal thoracic artery and gastroepiploic artery) was measured four times during the course of coronary artery bypass grafting. Graft flow just before sternal closure was almost equivalent to that in the preoperative phase when the anastomosis was optimal. Use of the Doppler miniprobe facilitated evaluation of the arterial graft flow pattern easily and quickly. We conclude that the Doppler miniprobe can provide helpful information for the evaluation of results of coronary artery bypass grafting in real time without necessitating any additional procedures.

Intraoperative coronary angiography using fluorescein

Intraoperative coronary angiography using fluorescein was applied to evaluate the patency of saphenous vein grafts just after completion of the distal anastomosis. By this technique, the area of the revascularized myocardium was well estimated in real time. This intraoperative direct-vision examination gives us more timely and precise information during coronary artery bypass grafting.

Intraoperative Coronary Angiography Using Fluorescein: Basic Studies and Clinical Application

To improve the safety and reliability of coronary artery bypass grafting (CABG), intraoperative coronary angiography using fluorescein was investi gated both experimentally and clinically. Results. In experiments using mongrel dogs, the optimal procedures were determined to be as follows. 1. Complete all distal anastomoses. 2. Under the illumination of a 6-watt black light hung 10 cm above the heart, 0.06% fluorescein (0.5 mg/kg BW) is injected as a bolus from the proximal end of the graft. Histologically the direct injection of fluorescein into the coronary artery was shown to cause no injury to the vascular wall. In clinical application, the distribution of the graft flow, the area perfused through the graft, and the patency of the anastomoses were well evaluated in real time by observing the fluorescence. Unexpected narrowing of the anasto mosis and the maldistribution of graft flow were detected in 2 patients by this examination during cardioplegic arrest, and the necessity for additional graft ing, as well as the extent of revascularization, could be evaluated on the operat ing table. It was concluded that intraoperative coronary angiography using fluorescein rapidly provided essential information for the real-time evaluation of CABG surgery without any side effects.