ROLE OF 64-SLICE MULTI DETECTOR COMPUTED TOMOGRAPHY FOR NON-INVASIVE VISUALISATION OF CORONARY ARTERY BYPASS GRAFTS FOR FOLLOW UP IN POST CABG PATIENTS
Abstract
Background: Coronary artery bypass graft surgery is a commonly performed revascularizationprocedure in ischemic heart disease patients. Conventional coronary angiography is an invasivemethod for evaluation of grafts in such patients. Non-invasive evaluation of grafts in post CABGpatient has been made possible with the advent of 64-Slice Multi Detector Computed Tomography(MDCT) .The Objective of the study was to non-invasively assess the graft patency with MDCT.Methods: Sixty post CABG patients (52 male, 8 female) with atypical chest pain or stable anginawere evaluated with MDCT for graft patency. The grafts were considered as patent if there wascontinuous lumen visualisation at origin, in the body and at its insertion with native recipientvessels. Grafts were defined as blocked when only stumps were seen. They were classified asstenotic if there was ≥50% diameter narrowing. Results: The mean age of the patients was60.1±9.7 years, mean duration since CABG was 8.01±6 years. Total number of grafts assessedwas 175 including 124 (71%) venous grafts and 51 (28.9%) arterial grafts. A total of 82/124(66.1%) venous grafts and 47/51 (92%) arterial grafts were patent. Forty-two (34%) venous graftswere blocked whereas 4 arterial grafts were not developed. Arterial grafts patency was 92% andvenous grafts patency was 67.7% after a mean follow up of 8.01±6 years. Conclusion: The studyshows that 64 slice MDCT can be used for the evaluation of patency and occlusion of venous andarterial grafts in post CABG patients for follow up.Keywords: Multi Detector Computed Tomography (MDCT), Coronary Artery Bypass Graft(CABG), Graft Patency (GP)References
Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenlund
K, Haase N, et al. Heart Disease and stroke statistics—2007
update: a report From the American Heart Association
Statistics Committee and Stroke Statistics Subcommittee.
Circulation 2007;115:e69–e171.
Cameron AA, Davis KB, Rogers WJ. Recurrence of angina
after coronary artery bypass surgery: predictors and prognosis
(CASS Registry) Coronary Artery Surgery Study. J Am Coll
Cardiol 1995;26:895–9.
Fitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper GD,
Burton JR. Coronary bypass graft fate and patient outcome:
angiographic follow-up of 5,065 grafts related to survival and
reoperation in 1,388 patients during 25 years. J Am Coll
Cardiol 1996;28:616–26.
Barner HB, Barnett MG. Fifteen- to twenty-one-year
angiographic assessment of internal thoracic artery as a
bypass conduit. Ann Thorac Surg 1994;57:1526–8.
Palmas W, Bingham S, Diamond GA, Denton TA, Kiat H,
Friedman JD, et al. Incremental prognostic value of exercise
thallium-201 myocardial single-photon emission computed
tomography late after coronary artery bypass surgery. J Am
Coll Cardiol 1995;25:403–9.
Gobel FL, Stewart WJ, Campeau L, Hickey A, Herd JA,
Forman S, White CW, Rosenberg Y. Safety of coronary
arteriography in clinically stable patients following coronary
bypass surgery. Post CABG Clinical trial Investigators.
Cathet Cardiovasc Diagn 1998;45:376–81.
Langerak SE, Vliegen HW, Roos AD, Zwinderman AH,
Jukema JW, Kunz P, et al. Detection of Vein Graft Disease
Using High-Resolution Magnetic Resonance Angiography.
Circulation 2002;105:328–33.
Schlosser T, Konorza T, Hunold P, Kühl H, Schmermund A,
Barkhausen J. Noninvasive visualization of coronary artery
bypass grafts using 16-detector row computed tomography. J
Am Coll Cardiol 2004;44:1224–9.
Martuscelli E, Romagnoli A, D’Eliseo A, Tomassini M,
Razzini C, Sperandio M, et al. Evaluation of Venous and
Arterial Conduit Patency by 16-Slice Spiral Computed
Tomography. Circulation 2004;110:3234–8.
Chiurlia E, Menozzi M, Ratti C, Romagnoli R, Modena
MG. Follow-up of coronary artery bypass graft patency by
multislice computed tomography. Am J Cardiol
;95:1094–7.
Raff GL, Gallagher MJ, O Neill WW, Goldstein JA.
Diagnostic accuracy of noninvasive coronary angiography
using 64-slice spiral computed tomography. J Am Coll
Cardiol 2005;46:552–7.
Pache G, Saueressig U, Frydrychowicz A, Foell D,
Ghanem N, Kotter E, et al. Initial experience with 64-slice
cardiac CT: non-invasive visualization of coronary artery
bypass grafts. Eur Heart J 2006;27:976–80.
Tepel M, Aspelin P, LameireN. Contrast-Induced
Nephropathy: A Clinical and Evidence-Based Approach.
Circulation 2006;113:1799–806.
Nieman K, Pattynama PMT, Rensing BJ, Van Geuns RJM,
De Feyter PJ.Evaluation of Patients after Coronary Artery
Bypass Surgery: CT Angiographic Assessment of Grafts and
Coronary Arteries.Radiology 2003;229:749–56.
Dewey M, Lembcke A, Enzweiler C, Hamm B, Rogalla P.
Isotropic half-millimeter angiography of coronary artery
bypass grafts with 16-slice computed tomography. Ann
Thorac Surg 2004;77:800–4.
Song M.H, Ito T, Watanabe T, Nakamura H. Multidetector
computed tomography versus coronary angiogram in
evaluation of coronary artery bypass grafts. Ann Thorac Surg
;79:585–8.
Bautista AT, Estornell J, Ridocci F, Soriano CJ, Gudín M,
Vilar JV, et al. Non-Invasive Assessment of Coronary Artery
Bypass Grafts by Computed Tomography: Comparison With
Conventional Coronary Angiography. Rev Esp Cardiol
;58:807–14.
Hamon M, Lepage O, Malagutti P, Riddell JW, Morello R,
Agostini D, et al. Diagnostic Performance of 16- and 64-
Section Spiral CT for Coronary Artery Bypass Graft
Assessment: Meta-Analysis. Radiology 2008;247:679–86.
Roberts WT, Bax JJ, Davies LC. Cardiac CT and CT
coronary angiography: technology and application.
Heart 2008;94:781–92.
Yamamoto M, Kimura F, Niinami H, Suda Y, Ueno E,
Takeuchi Y. Noninvasive assessment of off-pump coronary
artery bypass surgery by 16-channel multidetector-row
computed tomography. Ann Thorac Surg 2006;81:820–7.
Batyraliev T, Ayalp M.R, Sercelik A, Karben Z, Dinler
G, Besnili F, et al. Complications of Cardiac Catheterization: A
Single-Center Study. Angiology 2005;56:75–80.
Wyman RM, Safian RD, Portway V, Skillman JJ, McKay
RG, Baim DS. Current complications of diagnostic and
therapeutic cardiac catheterization. J Am Coll Cardiol
;12:1400–6.
Motwani JG. ,Topol E J. Aortocoronary Saphenous Vein
Graft Disease : Pathogenesis, Predisposition, and
Prevention. Circulation 1998;97:916–31.
VanDomburg RT, Foley DP, Breeman A, Van Herwerden
LA, Serruys PW. Coronary artery bypass graft surgery and
percutaneous transluminal coronary angioplasty. Twenty-year
clinical outcome. Eur Heart J 2002;23:543–9.
Ropers D, Ulzheimer S, Wenkel E, Baum U, Giesler T,
Derlien H, et al. Investigation of aortocoronary artery bypass
grafts by multislice spiral computed tomography with
electrocardiographic-gated image reconstruction. Am J
Cardiol 2001;88:792–5.
Stauder NI, Fenchel M, Stauder H, Küttner A, Scheule AM,
Kramer U, et al. Assessment of minimally invasive direct
coronary artery bypass grafting of the left internal thoracic
artery by means of magnetic resonance imaging. J Thorac
Cardiovasc Surg 2005;129:607–14.
Langerak SE, Vliegen HW, Jukema JW, Kunz P,
Zwinderman AH, Lamb HJ, et al. Value of magnetic
resonance imaging for the noninvasive detection of stenosis
in coronary artery bypass grafts and recipient coronary
arteries. Circulation 2003;107:1502–8.
Hausleiter J, Meyer T, Hadamitzky M, Huber E, Zankl M,
Martinoff S, et al. Radiation Dose Estimates From Cardiac
Multislice Computed Tomography in Daily Practice: Impact
of Different Scanning Protocols on Effective Dose
Estimates. Circulation 2006;113:1305–10.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
