Volume 33, Issue 2 (May 2022)                   Studies in Medical Sciences 2022, 33(2): 131-139 | Back to browse issues page

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Cardiologist, Shariati Hospital, University of Tehran, Tehran, Iran (Corresponding Author) , rezaee.mahrokh@gmail.com
Abstract:   (572 Views)
Background & Aims: Coronary artery bypass graft surgery (CABG) is evaluated by measuring coronary sinus parameters through angiography or transesophageal echocardiography. However, there is little information about the changes related to these indicators, especially about the changes in the diameter and flow of the coronary sinus through transthoracic echo evaluation. The purpose of this study was to investigate coronary sinus flow in transthoracic echo in the patients with left ventricular ejection fraction (LVEF) more than 45% before and after CABG surgery.
Materials & Methods: In this clinical trial study, 30 patients with coronary heart disease and LVEF greater than 45% who were candidates for CABG were included in the study. Before CABG surgery, patients underwent transthoracic echocardiography, and coronary sinus peak velocity, coronary sinus blood flow (CSBF), and velocity time integral index (VTI) were measured. These values ​​evaluated again after coronary artery grafts and their difference was evaluated. SPSS version 23 software was used for statistical analysis of data and t-test, chi-square test and paired t-test statistical methods were used. P value below 0.05 was considered as significance level.
Results: There was a significant difference between CSBF before (53.93±6.18) and after surgery (58.95±6.75) (P<0.001), which indicates a significant increase in this index after CABG surgery. Also, coronary sinus VTI index (CS-VTI) before surgery was 8.11 ± 0.70 and after surgery was 8.87 ± 0.82 (P<0.001). Coronary sinus diameter index (CSd) was 6.64±0.47 before surgery and 6.65±0.47 after surgery, which change was not significant (P=0.161). Also, the increase in CSBF after surgery adjusted for baseline variables was significant (P<0.001). None of the indicators of sex, age, cardiac risk factors, and the number of coronary arteries involved had significant correlations with CSBF.
Conclusion: The results of this study showed that transthoracic echocardiography significantly improves the amount of CSBF following CABG in these patients, which were completely independent from background information such as demographic characteristics, cardiovascular risk factors, and even the severity of vascular involvement in the coronary artery veins. Improvement in CSBF can occur without changes in coronary sinus diameter.

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1. Mantini E, Grondin CM, Lillehei CW, Edwards JE. Congenital anomalies involving the coronary sinus. Circulation 1966;33(2):317-27. [DOI:10.1161/01.CIR.33.2.317]
2. Snider AR, Ports TA, Silverman NH. Venous anomalies of the coronary sinus: detection by M-mode, two-dimensional and contrast echocardiography. Circulation 1979;60(4):721-7. [DOI:10.1161/01.CIR.60.4.721] [PMID]
3. Standring S, Ellis H, Healy J, Johnson D, Williams A, Collins P, et al. Gray's anatomy: the anatomical basis of clinical practice. American journal of neuroradiology 2005;26(10):2703. [Google Scholar]
4. Ng DW, Vlachonassios K, Nimalasuriya AR, Nguyen VT, Wijesekera C, Khan A, et al. Usefulness of transthoracic echocardiography in demonstrating coronary blood flow after coronary artery bypass grafting. Am J Cardiol 2004;93(7):923-5. [DOI:10.1016/j.amjcard.2003.12.037] [PMID]
5. Ganz W, Tamura K, Marcus HS, Donoso R, Yoshida S, Swan HJ. Measurement of coronary sinus blood flow by continuous thermodilution in man. Circulation 1971;44(2):181-95. [DOI:10.1161/01.CIR.44.2.181] [PMID]
6. Siostrzonek P, Kranz A, Heinz G, Rodler S, Gossinger H, Kreiner G, et al. Noninvasive estimation of coronary flow reserve by transesophageal Doppler measurement of coronary sinus flow. Am J Cardiol 1993;72(17):1334-7. [DOI:10.1016/0002-9149(93)90314-3] [PMID]
7. Potkin BN, Roberts WC. Size of coronary sinus at necropsy in subjects without cardiac disease and in patients with various cardiac conditions. The American journal of cardiology 1987;60(16):1418-21. [DOI:10.1016/0002-9149(87)90638-2] [PMID]
8. D'Cruz IA, Johns C, Shala MB. Dynamic cyclic changes in coronary sinus caliber in patients with and without congestive heart failure. American Journal of Cardiology 1999;83(2):275-7. [DOI:10.1016/S0002-9149(98)00838-8] [PMID]
9. Weyman AE. Principles and practice of echocardiography: Lea & Febiger; 1994. [URL]
10. Konecky N, Freedberg RS, McCauley D, Kronzon I. Absent right and persistent left superior vena cava without other congenital anomaly: a rare combination diagnosed by transesophageal echocardiography. Journal of the American Society of Echocardiography 1995;8(5):761-6. [DOI:10.1016/S0894-7317(05)80397-9] [PMID]
11. Toyota S, Amaki Y. Measurement of coronary sinus flow using transesophageal echocardiography in patients undergoing coronary artery bypass grafting. Journal of clinical anesthesia 2000;12(4):270-2. [DOI:10.1016/S0952-8180(00)00153-7] [PMID]
12. Nagaraja P, Singh NG, Patil T, Manjunath V, Prasad S, Jagadeesh A, et al. Transesophageal echocardiography estimation of coronary sinus blood flow for the adequacy of revascularization in patients undergoing off-pump coronary artery bypass graft. Annals of cardiac anaesthesia 2015;18(3):380. [DOI:10.4103/0971-9784.159809] [PMID] [PMCID]
13. Toufan M, Samadikhah J, Alizadeh-Asl A, Azarfarin R, Hakim S, Yaghoubi A, et al. Measurement of coronary sinus blood flow after first anterior myocardial infarction with transthoracic echocardiography and its correlation with wall motion scoring index. Saudi medical journal 2007;28(10):1545. [DOI:10.1016/S0167-5273(08)70453-4]
14. Bergler-Klein J. Global longitudinal strain for predicting outcome after mitral repair or cardiac surgery: here to stay?: Oxford University Press; 2013. p. 12-4. [DOI:10.1093/ehjci/jes209] [PMID]
15. Chen Y, Zhang Z, Cheng L, Fan L, Wang C, Shu X. The early variation of left ventricular strain after aortic valve replacement by three-dimensional echocardiography. PLoS One 2015;10(10):e0140469. [DOI:10.1371/journal.pone.0140469] [PMID] [PMCID]

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