The impact of ligation of proximal side branches on blood flow and functional status of the internal thoracic artery in coronary anastomosis.

BACKGROUND: The effect of proximal side branches on the patency of the internal thoracic artery (ITA) is controversial. We used echocardiography and Doppler to verify the effect of ligation of branches on the flow and coronary flow reserve (CFR) of the grafted ITA in patients after coronary artery bypass grafting (CABG). METHODS: We prospectively investigated 53 patients with preserved left ventricular ejection fraction (LVEF >50%) who underwent CABG of the ITA. In Group I (25 patients), major branches were ligated during ITA anastomosis to the left anterior descending (LAD) coronary artery, whereas no ligation was performed in Group II (28 patients). Systolic flow (SF), diastolic flow (DF), and total flow (TF = SF + DF) were measured by Doppler echocardiography at the proximal level of the ITA preoperatively, at early postoperative stage, and 6 months after surgery. Dobutamine stress echocardiography (DSE) was performed at 6 months to determine CFR. RESULTS: The ITA flow was predominantly systolic before surgery and diastolic in the postoperative period. We found no differences between the groups in DF. On DSE, SF (19.5±9 mL/min vs 32.7±19 mL/min; P=.003) and TF (79±21 mL/min vs 101±47 mL/min; P=.037) were higher in Group II. There were no differences in CFR (1.9±0.46 vs 2.11±0.56; P=.143). CONCLUSION: In patients with preserved LVEF, ligation of major side branches during anastomosis to the LAD does not alter ITA flow or CFR.

Autopsy findings in the lupus heart

Vinte e dois casos de LES acompanhados no Hospital das Clínicas da Universidade Federal do Ceará que foram submetidos à autópsia foram revisados, com ênfase para as anormalidades cardíacas. O material, incluído em parafina, de 20 desses casos foi processado para coloraçao pela hematoxilina- eosina e procedeu-se à reanálise de microscopia. Achados clínicos cardíacos fo ram relatados em 41 por cento dos casos, enquanto que foram encontradas altera çoes em 65 por cento dos casos disponíveis para análise histopatológica. Clinicamente, pericardite foi a anormalidade predominante (23 por cento). A autópsia, o pericárdio foi também o folheto mais freqüente envolvido (45,5 por cento), se guido pelo miocárdio (36,4 por cento) e endocárdio (22,7 por cento). Os achados clínicos e de autópsia assemelham-se aos dados de literatura. Os autores alertam para a importância da pesquisa de alteraçoes cardíacas no LES, uma vez que o reconhecimento precoce pode influir no prognóstico