Case No. 1: Y SVG-PLB, PDA Graft with Low Flow in One Branch
A 66-year-old male with multi-vessel coronary artery disease underwent CABG surgery. A saphenous vein Y graft was anastomosed to the Posterior Descending Artery (PDA) and to the Posterior Lateral Branch (PLB). When the PDA branch was occluded and flow was measured in the PLB, mean flow was only 5 mL/min, but the flow exhibited a good systolic/diastolic wave pattern. Negative troughs in the flow profile indicate that the mean flow of that branch of the Y was being compromised by competitive flow from the native coronary. Flow in the PDA branch was 25 mL/min, indicating that most of the flow was going through that branch of the Y graft. A vein graft was subsequently anastomosed to the obtuse marginal coronary (OM) in the patient to improve flow to the distal myocardium.
The three waveforms show the acceptable flow waveforms of a Y graft to the PDA and PLB, even though flow to the PLB was low (5 mL/min) due to competitive flow from the native coronary artery.
Case No. 2: Three Arterial Grafts with Good Flows/Waveforms
A number of cardiothoracic surgeons now prefer to use arterial conduits exclusively to achieve coronary revascularization. The following case illustrates this preference. A 70-year-old male underwent CABG surgery. The surgeon chose to use only arterial grafts during the surgery. The left internal mammary artery (LIMA) was anastomosed to the left anterior descending coronary artery (LAD); the right internal mammary artery was connected to the right coronary artery (RCA) and the radial (Rad) artery was harvested from the forearm and anastomosed to the posterior descending coronary artery (PDA). All three grafts exhibited good flows and excellent waveforms.
These three arterial grafts all exhibit good flows, acceptable PIs and excellent waveform profiles.
Case No. 3: Phenomenal 17-Year-Old Graft Flow in 90-Year-Old Patient
A 90-year-old woman with cardiac symptoms underwent off-CPB CABG. She had had CABG surgery 17 years before when she was 73 years old. The surgeon measured flow in an old SVG-OM1, OM2 Y graft and was astounded to find that the old Y graft was still delivering 120 mL/min to the myocardium.
This 17-year-old Y graft to the OM1, OM2 exhibited phenomenal flow of 120 mL/min in a 90-year-old woman.