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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 465-468, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
GJ Cooper, GA Wilkinson and GD Angelini
After mobilization, vasospasm often reduces flow through the internal
mammary artery. An established method of relaxing the artery and increasing
flow is to wrap it in a papaverine-soaked swab. To our knowledge the
ability of other topical vasodilators to overcome spasm of the internal
mammary artery has not been studied clinically. In 50 patients in whom the
left mammary artery was used for myocardial revascularization, we have
investigated the effect of five agents on internal mammary artery free
flow. The agents investigated were normal saline, papaverine, nifedipine,
glyceryl trinitrate, and sodium nitroprusside. Under controlled hemodynamic
conditions, free flow was measured before any pharmacologic intervention
and a median of 18.5 minutes after the pedicle had been sprayed with one of
the five agents. Normal saline produced a small increase in flow from a
median of 23 ml/min (range 17 to 88) to 38 ml/min (20 to 84) (not
significant), whereas a significant increase occurred with papaverine, from
25 (16 to 78) to 43 ml/min (34 to 112) (p less than 0.01). Nifedipine and
glyceryl trinitrate raised free flow by almost threefold, from 23 (14 to
66) to 71 ml/min (45 to 118) and from 23 (14 to 58) to 62 ml/min (46 to
126), respectively (both p less than 0.001). Sodium nitroprusside, however,
with an increase in flow from 26 (10 to 58) to 108 ml/min (46 to 196), 250%
over control, proved to be more effective than nifedipine and glyceryl
trinitrate (p less than 0.05). We therefore recommend the topical use of
sodium nitroprusside to relieve perioperative spasm of the internal mammary
artery.
ARTICLES
Overcoming perioperative spasm of the internal mammary artery: which is the best vasodilator?
Department of Cardiac Surgery, Northern General Hospital, Sheffield, United Kingdom.
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