Subject(s)
Aortic Valve Insufficiency/surgery , Cardiovascular Surgical Procedures , Coronary Circulation/physiology , Mitral Valve Insufficiency/surgery , Adolescent , Adult , Aged , Aortic Valve Insufficiency/physiopathology , Female , Heart Valve Prosthesis , Humans , Male , Microcirculation/physiology , Middle Aged , Mitral Valve Insufficiency/physiopathology , Treatment OutcomeABSTRACT
Radial artery (RA) is rather commonly used as a graft for autoarterial myocardial revascularization. Consequences of RA harvesting for the development of ischemic disturbances in distal hand segments are poorly understood. The paper presents assessment of hand microcirculation (HMC) before and in late postoperative period after RA harvesting with modern precise diagnostic method - laser Doppler flowmetry (LDF). LDF assessment of HMC was carried out in 80 patients with ischemic heart disease (160 hands) to evaluate the possibility of RA harvesting for coronary artery bypass surgery. HMC classification was developed on the base of these measurements: type 1 -normocirculatory HMC: 6.7-17 ml/min/100 g (58%); type 2 - vasospastic HMC: < or = 6.7 ml/min/100 g (20%); type 3 - hyperemic HMC: > or = 17 ml/min/100 g (22%). In 34% of cases preoperative examination revealed microcirculatory asymmetry between right and left hands. Based on preoperative examination results in 22.9% of cases the decision was made to refuse from RA excision because of positive collateral circulation test developed in our Institute (positive decision about Patent award according to appeal No2000122582/14 (023905) from 28.08.2000). In 14 patients (14 upper extremities) HMC was measured before and 1-1.5 years after RA harvesting. After RA excision baseline HMC in operated hand reduced significantly while maximal HMC reserve remained at the level close to preoperative one. Postoperative HNMC alterations evidence of adequate preoperative assessment of hand collateral circulation potential. In case of blood flow asymmetry RA must be taken from the hand with higher blood supply and adequate collateral microcirculation.
Subject(s)
Coronary Artery Bypass , Hand/blood supply , Myocardial Ischemia/surgery , Radial Artery/diagnostic imaging , Radial Artery/transplantation , Upper Extremity/blood supply , Arteriovenous Shunt, Surgical/methods , Collateral Circulation/physiology , Female , Humans , Laser-Doppler Flowmetry , Male , Microcirculation , Middle Aged , Myocardial Ischemia/diagnosis , Myocardial Ischemia/physiopathology , Postoperative Care , Preoperative Care , Tissue and Organ Harvesting , UltrasonographyABSTRACT
Laser doppler flowmetry was used for the intraoperative study of myocardial blood flow before and after revascularization in 116 patients with 2-3 vessel coronary artery disease and class II-IV angina. In patients without myocardial infarction, with microfocal myocardial infarction, or operated early after myocardial infarction revascularization caused no significant increase of myocardial blood flow. In patients with macrofocal infarction surgery was associated with significant increase of myocardial blood flow. Efficacy of revascularization could be assessed by lowering of flow gradients between various regions of the myocardium.
