Comparison of perioperative and postoperative phasic blood flow in aortocoronary venous bypass grafts by means of pulsed Doppler echocardiography with implantable microprobes.

Although graft dimension and hemodynamic variables have been suggested as important determinants of the functional results of aortocoronary bypass grafting, there is no easy-to-use bedside method of monitoring phasic blood flow in coronary bypass grafts. We developed a miniaturized implantable silicone pulsed Doppler flow probe linked to a classic 8 MHz pulsed Doppler system. This apparatus has an adjustable range-gated time system that permits accurate measurement of diameter (D, in mm), cross-sectional blood flow velocity (Vm, in cm/sec), and coronary bypass graft flow (CBGF, in ml/min) as pi D2/4 X Vm X 60. Ten patients (55 +/- 7.2 years SD) with preoperative left ventricular ejection fractions over 45% received the implantable flow probes during the aortocoronary venous bypass procedure. Closure of the chest altered systolic and diastolic components of flow velocity and CBGF decreased from 131 +/- 65.8 to 94 +/- 55 ml/min (-28%; p less than .01). Comparison between early postoperative values (intensive care unit) and values 6 days later showed significant increases in diameter from 4.2 +/- 0.9 to 5.3 +/- 0.9 mm (p less than .01) and in CBGF from 130 +/- 112 to 204 +/- 86 ml/min (p less than .01). We conclude that the implantable pulsed Doppler microprobe is a sensitive bedside method for monitoring aortocoronary bypass graft diameter and blood flow in the postoperative period.