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(Radiology. 2000;216:123-127.)
© RSNA, 2000

Cardiac Imaging

CT and Arteriography in the Evaluation of Indirect Myocardial Revascularization with a Free-Muscle Transplant: Initial Experience1

Stefan C. Krämer, MD, Johannes Görich, MD, Michael Beyer, MD, Elmar Merkle, MD, Jaqueline Gerber, MD, Norbert Rilinger, MD, Roman Sokiranski, MD and Hans-Jürgen Brambs, MD

1 From the Departments of Radiology (S.C.K., J. Görich, E.M., N.R., R.S., H.J.B.) and Cardiosurgery (M.B., J. Gerber), University of Ulm, Steinhövelstrasse 9, 89075 Ulm, Germany. Received July 12, 1999; revision requested August 16; revision received November 1; accepted November 10. Address correspondence to S.C.K. (e-mail: stefan.kraemer@medizin.uni-ulm.dc).

PURPOSE: To examine patients with advanced cardiovascular disease with radiology after indirect myocardial revascularization with a free-skeletal-muscle transplant and to determine whether the attached vessel remains patent over the middle and long terms.

MATERIALS AND METHODS: In 10 patients with advanced, inoperable cardiovascular disease treated with indirect myocardial revascularization with a free-muscle transplant, radiologic follow-up was performed postoperatively and every 6 months. All 10 patients underwent selective arteriography of the anastomosed vessel and contrast material–enhanced helical computed tomography (CT) (transverse sections and reconstructions).

RESULTS: All patients showed adequate vascular conditions postoperatively, as did nine of 10 patients after 1 year. In one patient, the anastomosed artery was occluded. CT showed time-dependent muscle degeneration in all patients. Postoperative, contrast-enhanced, superselective CT showed an area of high-attenuating uptake in the muscle transplant in all patients. After 1 year, CT depicted perfusion defects of the skeletal muscle in two patients. In eight patients, however, small vascular bridges from the skeletal muscle to the myocardium were detected. Radiologic results correlated well with clinical outcome and stress electrocardiograms.

CONCLUSION: Helical intraarterial CT and arteriography were sensitive in depicting enhancement and remaining vital function in nine of 10 patients after indirect myocardial revascularization with a free-muscle transplant. This combination seems promising for postoperative examination in such patients.

Index terms: Angiography, 51.1242 • Heart, CT, 51.12115, 51.12116, 51.12117 • Heart, surgery, 51.454 • Myocardium, abnormalities, 511.7644 • Myocardium, blood supply, 511.76 • Myocardium, ischemia, 511.76






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