The internal mammary artery malperfusion syndrome: incidence, treatment and angiographic verification.

Details

Serval ID
serval:BIB_7D7060BA019A
Type
Article: article from journal or magazin.
Collection
Publications
Title
The internal mammary artery malperfusion syndrome: incidence, treatment and angiographic verification.
Journal
European Journal of Cardio-thoracic Surgery
Author(s)
Carrel T., Kujawski T., Zünd G., Schwitter J., Amann F.W., Gallino A., Bertel O., Jenni R., Turina M.
ISSN
1010-7940 (Print)
ISSN-L
1010-7940
Publication state
Published
Issued date
1995
Volume
9
Number
4
Pages
190-5; discussion 196-7
Language
english
Abstract
Internal mammary artery (IMA) malperfusion syndrome is caused by an acute imbalance between myocardial demand and nutritional support through the mammary artery. In a consecutive series of 2326 isolated myocardial revascularizations-with at least one IMA to the left anterior descending branch (LAD) in 91.3% (2125/2326)-we identified 45 patients (1.9%) with a perioperative course suggesting IMA malperfusion syndrome. Additional saphenous vein graft to the distal segment of the LAD was performed during normothermic ventricular fibrillation in all patients. Hospital mortality was 4.4% (2/45), intra-aortic balloon pumping was required in 15.5% (7/45) and anterior myocardial infarction occurred in 28.8% (13/45). Coronary angiography was performed in all survivors between 3 and 24 months postoperatively. Wide patent IMA graft and patent saphenous vein graft were observed in 56% (24/43), narrowed but patent IMA graft and patent vein graft in 35% (15/43), while patent vein graft and not visualized IMA in 7% (3/43); in one patient with severely diseased peripheral LAD, no flow could be demonstrated in the IMA graft or in the additional vein graft (1/43, 2.4%). No major differences were found between early and late coronary angiography in these patients. Additional vein graft to distal LAD is the treatment of choice in acute IMA malperfusion syndrome. Despite patent vein graft with superior blood flow, early and late postoperative IMA flow to LAD is maintained in the majority of patients.
Keywords
Adult, Aged, Coronary Angiography, Coronary Disease/surgery, Female, Graft Occlusion, Vascular/epidemiology, Graft Occlusion, Vascular/radiography, Humans, Incidence, Male, Mammary Arteries/transplantation, Middle Aged, Myocardial Reperfusion, Reoperation, Saphenous Vein/transplantation, Syndrome, Vascular Patency
Pubmed
Web of science
Create date
07/09/2011 18:39
Last modification date
20/08/2019 14:38
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