Vineberg's procedure modified technique: flow analysis, immediate postoperative results and angiographic evaluation.

BACKGROUND: The purpose of this study was to evaluate angiographic results of patients subjected to a technique variation of Vineberg's procedure, as well as their morbidity and mortality in immediate postoperative period, and to analyze the flow of grafted left internal thoracic artery (LITA) at rest and under stress. METHODS: Between September 1999 and April 2002 eight patients were operated upon, with implant of the internal thoracic artery (ITA) in the intimal layer of the left ventricle (LV) muscle. After 6 months, they underwent angiographic and Doppler evaluation. According to Doppler study of LITA, the sample was divided in two groups: "Vineberg group," formed by eight patients; and "control group" consisting of 20 patients whose LITA directly revascularize the anterior interventricular artery (AIV). Angiography showed patency of all grafts in both groups. Blood flow and flow velocity in grafts were measured by Doppler echocardiography. T-test for paired and unpaired samples were used for statistical analysis. RESULTS: There were no deaths or complications in immediate postoperative period. Angiography showed 100% patency. The total flow (TF) of Vineberg group was 55% of the flow in the control group. In both groups, the TF increased with the stress. CONCLUSIONS: This Vineberg's technique modification can be successfully used in patients who cannot undergo traditional direct revascularization due to its low rates of morbidity and mortality and a high rate of patency, providing a significant blood flow both at rest and under stress.

Flow analysis of left internal thoracic artery in myocardial revascularization surgery using y graft.

In order to evaluate the left internal thoracic artery flow pattern, when the vessel is used as a graft to supply the left coronary artery system, we evaluated flow by Doppler measurement, both at rest and under dobutamine stress. There were 2 groups of 20 patients each: group A patients received only a left internal thoracic artery graft to the left anterior descending artery, and group B patients received a pedicled left internal thoracic artery graft associated with a vein graft, which together supplied the left anterior descending artery and another branch of the left coronary artery. Angiography showed patent grafts in all patients from both groups. The following characteristics were evaluated: systolic flow, diastolic flow, total flow, total flow under stress/total flow at rest ratio, systolic peak velocity, diastolic peak velocity, and systolic peak velocity/diastolic peak velocity ratio. In group A, the total flow was 45.5 +/- 21.6 mL/min at rest and 68.3 +/- 32.9 mL/min under stress. In group B, the total flow was 98.2 +/- 50.4 mL/min at rest and 175.7 +/- 79.2 mL/min under stress. Comparison between groups showed a total flow increase in group B of 115.8% (P=0.0002) at rest and 157.2% (P <0.0001) under stress. The other characteristics were also statistically significant, except systolic flow, total flow under stress/total flow at rest ratio, and systolic peak velocity. Our results showed that the left internal thoracic artery sufficiently supplies regional myocardium at rest and during exercise (stress), demonstrating its great adaptability in response to demand.