Assessment of the internal mammary artery using ultrasound in patients with coronary artery disease before coronary artery bypass grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Rui ¹ , WEI Qing ² , MA Xiaoyan ³ , GUAN Qiang ¹ , CHU Junmin ¹ , WANG Liqing ¹ , SUN Hansong ¹ , SONG Yunhu ¹ ,  SHEN Liuzhong ¹

1. Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P. R. China;
2. Department of Ultrasound Imaging Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P. R. China;
3. Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P. R. China;

Corresponding author：

SHEN Liuzhong, Email: shen_liuzhong@163.com

Keywords：

Internal mammary artery; ultrasound; coronary heart disease; vascular internal diameter; blood flow

DOI：

10.7507/1007-4848.202103043

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Objective To investigate the feasibility and effectiveness of using ultrasound to evaluate the internal mammary artery (IMA) and explore the related factors affecting the quality of IMA.Methods From July 2020 to January 2021, for patients who underwent coronary artery bypass grafting at the Department of Cardiovascular Surgery, Fuwai Hospital, ultrasound was applied to measure bilateral IMA at the parasternal second intercostal space. There were 62 males and 18 females with an average age of 59.9±8.3 years. The clinical data of the patients were recorded and analyzed.Results A total of 160 IMA were measured. The IMA was detected in 99.4% (159/160), and the one that was not measured was proved to be occluded by enhanced CT. A total of 157 (98.1%) IMA intima were smooth, 2 (1.3%) were found to have uneven intimal thickening and less smooth, and only 1 (0.6%) was occluded. The intravascular diameter, peak systolic flow rate, peak diastolic flow rate, and blood flow rate of the left second intercostal IMA were 1.9±0.3 mm, 66.8±17.7 cm/s, 6.4 (0.0, 9.7) cm/s, 19.7±9.4 mL/min; and those of the right one were 2.1±0.3 mm, 69.7±18.5 cm/s, 6.0 (0.0, 9.2) cm/s and 22.8±11.5 mL/min, respectively. IMA vessel diameter and blood flow were greater on the right than those on the left side in the same individual (P<0.01). In univariate analysis, sex and body surface area were the factors that influenced the size of the IMA vessel among different individuals, and by linear regression analysis, the size of the IMA vessel was only related to body surface area among different individuals. On univariate analysis, diabetes mellitus was the only factor affecting IMA blood flow, with a mean reduction in blood flow of 18.4% (left) and 21.7% (right) in the diabetic group (P<0.05).Conclusion Preoperative evaluation of the IMA using ultrasound over the parasternal second intercostal space is easy, noninvasive, and has a high success rate. The internal diameter of the IMA is positively correlated with body surface area, and blood flow is significantly reduced in patients with diabetes.

Citation： LIU Rui, WEI Qing, MA Xiaoyan, GUAN Qiang, CHU Junmin, WANG Liqing, SUN Hansong, SONG Yunhu, SHEN Liuzhong. Assessment of the internal mammary artery using ultrasound in patients with coronary artery disease before coronary artery bypass grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(2): 249-252. doi: 10.7507/1007-4848.202103043 Copy

1.	Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. EuroIntervention, 2019, 14(14): 1435-1534.
2.	关欣, 喻晓娜, 吕增诚, 等. 冠心病患者胸廓内动脉的超声检测. 中华超声影像学杂志, 2003, 12(1): 49-50.
3.	Green GE, Stertzer SH, Reppert EH. Coronary arterial bypass grafts. Ann Thorac Surg, 1968, 5(5): 443-450.
4.	Li D, Gu S, Liu Y , et al. Outcomes of left internal mammary artery with saphenous vein composite graft to bypass the left anterior descending artery: A propensity-matched study. J Thorac Dis, 2020, 12(11): 6629-6639.
5.	Fonseca DA, Antunes PE, Cotrim MD. Ultrastructural and histomorphologic properties of the internal thoracic artery: Implications for coronary revascularization. Coron Artery Dis, 2017, 28(6): 518-527.
6.	Kawaue Y, Hayashi S. Description of arterial grafts from the aspect of preoperative angiography. Nihon Kyobu Geka Gakkai Zasshi, 1994, 42(1): 13-17.
7.	王学廷, 潘为领, 王涛. 多层螺旋CT血管造影在显示内乳动脉的应用价值. 实用放射学杂志, 2008, 24(8): 1088-1089, 1097.
8.	Bryan AJ, Barnard SP. Transcutaneous ultrasound measurement of flow in internal mammary artery. Lancet, 1992, 339(8797): 869.
9.	吴炜, 马佳, 田津. 乳内动脉的超声检查. 中国超声医学杂志, 1999, 15(4): 262-265.
10.	Goto Y, Atsumi H, Kadowaki K, et al. Noninvasive assessment of left internal thoracic artery graft patency using transthoracic echocardiography. Nihon Kyobu Geka Gakkai Zasshi, 1993, 41(10): 2013-2018.
11.	Ohtani N, Kiyokawa K, Asada H, et al. Evaluation of an internal thoracic artery as a coronary artery bypass graft by intercostal duplex scanning ultrasonography. Jpn J Thorac Cardiovasc Surg, 2001, 49(6): 343-346.
12.	Singh RN, Sosa JA. Internal mammary artery: A "live" conduit for coronary bypass. J Thorac Cardiovasc Surg, 1984, 87(6): 936-938.
13.	袁建军, 鲁豫, 程兆云, 等. 乳内动脉的二维及彩色多普勒超声评价. 中国超声医学杂志, 2001, 17(8): 578-580.
14.	钱嵘, 赵宝珍, 李卫萍, 等. 早期糖尿病患者外周血管和肱动脉舒张功能的检测分析. 上海医学影像, 2003, 12(4): 290-291, 297.
15.	仲肇基, 郑哲, 王小啟, 等. 糖尿病患者行双侧乳内动脉冠状动脉旁路移植术早期结果分析. 中国胸心血管外科临床杂志, 2018, 25(12): 1038-1042.

1. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. EuroIntervention, 2019, 14(14): 1435-1534.
2. 关欣, 喻晓娜, 吕增诚, 等. 冠心病患者胸廓内动脉的超声检测. 中华超声影像学杂志, 2003, 12(1): 49-50.
3. Green GE, Stertzer SH, Reppert EH. Coronary arterial bypass grafts. Ann Thorac Surg, 1968, 5(5): 443-450.
4. Li D, Gu S, Liu Y , et al. Outcomes of left internal mammary artery with saphenous vein composite graft to bypass the left anterior descending artery: A propensity-matched study. J Thorac Dis, 2020, 12(11): 6629-6639.
5. Fonseca DA, Antunes PE, Cotrim MD. Ultrastructural and histomorphologic properties of the internal thoracic artery: Implications for coronary revascularization. Coron Artery Dis, 2017, 28(6): 518-527.
6. Kawaue Y, Hayashi S. Description of arterial grafts from the aspect of preoperative angiography. Nihon Kyobu Geka Gakkai Zasshi, 1994, 42(1): 13-17.
7. 王学廷, 潘为领, 王涛. 多层螺旋CT血管造影在显示内乳动脉的应用价值. 实用放射学杂志, 2008, 24(8): 1088-1089, 1097.
8. Bryan AJ, Barnard SP. Transcutaneous ultrasound measurement of flow in internal mammary artery. Lancet, 1992, 339(8797): 869.
9. 吴炜, 马佳, 田津. 乳内动脉的超声检查. 中国超声医学杂志, 1999, 15(4): 262-265.
10. Goto Y, Atsumi H, Kadowaki K, et al. Noninvasive assessment of left internal thoracic artery graft patency using transthoracic echocardiography. Nihon Kyobu Geka Gakkai Zasshi, 1993, 41(10): 2013-2018.
11. Ohtani N, Kiyokawa K, Asada H, et al. Evaluation of an internal thoracic artery as a coronary artery bypass graft by intercostal duplex scanning ultrasonography. Jpn J Thorac Cardiovasc Surg, 2001, 49(6): 343-346.
12. Singh RN, Sosa JA. Internal mammary artery: A "live" conduit for coronary bypass. J Thorac Cardiovasc Surg, 1984, 87(6): 936-938.
13. 袁建军, 鲁豫, 程兆云, 等. 乳内动脉的二维及彩色多普勒超声评价. 中国超声医学杂志, 2001, 17(8): 578-580.
14. 钱嵘, 赵宝珍, 李卫萍, 等. 早期糖尿病患者外周血管和肱动脉舒张功能的检测分析. 上海医学影像, 2003, 12(4): 290-291, 297.
15. 仲肇基, 郑哲, 王小啟, 等. 糖尿病患者行双侧乳内动脉冠状动脉旁路移植术早期结果分析. 中国胸心血管外科临床杂志, 2018, 25(12): 1038-1042.

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