• Masahiko Kuroda, Hiroshi Hamada, Masashi Kawamoto, Kazumasa Orihashi, Taijiro Sueda, Masaya Otsuka, and Osafumi Yuge.
• Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan. kurodam@hiroshima-u.ac.jp
• J. Cardiothorac. Vasc. Anesth. 2009 Dec 1;23(6):822-7.

ObjectiveThe purpose of this study was to evaluate intraoperative transesophageal echocardiography (TEE) for assessing patency of internal thoracic artery grafts.DesignA retrospective study.SettingA university hospital.ParticipantsFifty-one consecutive patients who underwent coronary artery bypass graft (CABG) surgery using the left internal thoracic artery (LITA)-to-left coronary artery were examined postoperatively with coronary angiography (CAG).InterventionsNone.Measurement And Main ResultsThe authors measured blood flow velocity using TEE after anastomosis of a LITA graft. Intraoperative TEE findings and routine CAG results were compared to evaluate the quality of TEE assessment. The LITA was detected in 45 of 51 patients (88%) intraoperatively with TEE. Peak and mean velocities and velocity time integral ratios were determined by dividing each diastolic value by its corresponding systolic value. The peak velocity ratio was 0.51 +/- 0.04 (range, 0.40-0.59) in the presence of stenosis and 1.14 +/- 0.10 (range, 0.58-3.87) in its absence (p = 0.0289), whereas mean velocity ratios were 0.62 +/- 0.05 (range, 0.45-0.72) and 1.27 +/- 0.10 (range, 0.66-4.08) (p = 0.0223), respectively, and velocity time integral ratios were 0.83 +/- 0.09 (range, 0.64-1.05) and 2.69 +/- 0.29 (range, 0.91-8.35) (p = 0.0224), respectively. The critical values for peak and mean velocities and velocity time integral ratios were 0.60, 0.73, and 1.06, respectively, whereas the sensitivity for each was 100% and the specificity was 92%, 94%, and 89%, respectively.ConclusionsThe authors concluded that the intraoperative assessment of LITA patency with TEE was a markedly useful and powerful tool for anesthesiologists during CABG surgery.

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