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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 406-411, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
GW He
The distal section of the internal mammary artery (3 to 4 cm proximal to
the bifurcation) is often used for coronary grafting. This part of the
artery is more pharmacologically responsive to vasoconstrictor agents than
is its midsection. The present study was designed to test the hypothesis
that the reactivity of the distal section of the internal mammary artery is
inversely correlated to the diameter of the artery. The distal section of
the human internal mammary artery was collected from aorta-coronary bypass
grafts and studied in organ baths at a length of 3 mm. At the optimal point
of the length-tension curves determined by a computer-iterative fitting
technique, the diameter at 100 mm Hg, the maximal contraction forces and
effective concentration causing 50% of the maximal response to
vasoconstrictor agents U46619, potassium chloride, alpha-adrenoceptor
agonists norepinephrine, methoxamine, and phenylephrine were recorded or
calculated. The maximal relaxation and 50% response to glyceryl trinitrate
in phenylephrine- precontracted internal mammary artery segments were also
calculated. The contraction force was standardized by the circumference
(grams per millimeter). Regression analysis between contraction force and
diameter revealed that the contraction force induced by U46619 and
potassium chloride was inversely correlated to diameter (r2 = 0.2, p <
0.05 in U46619-induced contraction and r2 = 0.2, p < 0.01 in potassium
chloride- induced contraction). The contraction force induced by
norepinephrine also had a trend inversely correlated to diameter (r2 = 0.2,
p = 0.07). Glyceryl trinitrate-induced relaxation was not correlated to
diameter. This study demonstrated that the contractility of the distal
section of the internal mammary artery is inversely correlated to the
diameter; that is, the smaller the diameter, the greater the tendency for
spasm to develop. This suggests that trimming off the distal end of the
internal mammary artery as much as possible may be the best way to prevent
graft spasm and that superior results of left internal mammary artery
grafted to the left anterior descending artery or the use of a "free graft"
may be related to the shorter length (distal end is trimmed off) and less
contractility of the graft.
ARTICLES
Contractility of the human internal mammary artery at the distal section increases toward the end. Emphasis on not using the end of the internal mammary artery for grafting
Royal Prince Alfred Hospital, Sydney, Australia.
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