Multi-detector Row CT Evaluation of Coronary Artery Bypass Graft Using Reverse Left Internal Mammary Artery: A Case Report

多切面電腦斷層評估以反向左內乳動脈施作之冠狀動脈繞道接枝術後患者：病例報告

陳詩華(Si-Wa Chan) ； 張燕(Yen Chang) ； 蔡依橙(I-Chen Tsai) ； 蔡瑋琳(Wei-Lin Tsai) ； 沈昭諭(Chao-Yu Shen) ； 林保鐘(Pao-Chun Lin) ； 陳啟昌(Clayton Chi-Chang Chen)

《中華放射線醫學雜誌》 34卷4期 (2009/12) Pp. 283-287

摘要

截至目前，許多研究都已證實多切面電腦斷層在評估冠狀動脈繞道接枝的準確性。但尚無研究或個案報告說明多切面電腦斷層在臨床上的實用性是否有可能超越心導管檢查。我們將介紹一位患者，由於手術中傷及近端內乳動脈，故繞道接枝以反向內乳動脈接續橈動脈完成三大冠狀動脈支配區域的血液供應。由於在技術上，反向內乳動脈以心導管是無法評估的，本例清楚說明多切面電腦斷層在評估複雜繞道接枝狀況時的優勢與實用性。

並列摘要

Many studies have shown that multi-detector row CT (MDCT) can accurately evaluate coronary artery bypass grafts. When compared with cardiac catheterization, the diagnostic accuracy of MDCT for coronary artery bypass graft is promising. However, to our knowledge, there has been no report showing if the clinical applicability of MDCT can surpass cardiac catheterization in certain circumstances. We will present a case, with iatrogenic injury of proximal left internal mammary artery (LIMA), received a composite arterial graft using reverse LIMA flow and radial artery to supply all three coronary territories. The reverse LIMA flow was from left inferior epigastric artery and two intercostal arteries, which is extremely difficult, if not impossible, to allow simultaneous catheterization and contrast injection. In this case, MDCT demonstrated its powerful capability in coronary artery bypass grafts with complex anatomy, resolving the limitations of the clinical applicability of cardiac catheterization.