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).
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Figure 1. Transverse contrast-enhanced helical CT scan obtained in a 54-year-old male patient 10 days after indirect myocardial revascularization by using a flap from the latissimus dorsi muscle shows the 1.8-cm thickness of the muscle flap (arrows) apposed to the epicardium, with substantial enhancement after intraarterial contrast medium injection. Vascular connections with the myocardium are not seen.
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Figure 2. Right-anterior-oblique (25° oblique) arteriogram obtained in the patient in Figure 1 after free-skeletal-muscle transplantation shows that the main catheter has been advanced to the site of the anastomosis of the vessel to the ascending aorta (curved arrow), while the attached dorsal thoracic artery (straight arrow) is catheterized with only the microcatheter. No evidence of stenosis is seen; a normal vascular course with branching into individual segments in the muscle also is seen.
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Figure 3. Transverse contrast-enhanced helical CT scan obtained at follow-up in a 69-year-old male patient 1 year after indirect revascularization shows the muscle transplant, with regular lateral perfusion (white arrows) and with an anterior perfusion defect (black arrows).
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Figure 4a. Contrast-enhanced helical CT images obtained in a 63-year-old male patient 1 year after myocardial revascularization show that contrast medium uptake in the muscle flap still is good, despite atrophy to a thickness of 0.6 cm. Fine projections of contrast medium (arrows) toward the myocardium are seen on both (a) transverse and (b) coronally reconstructed sections and have been interpreted as evidence of vascular connections.
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Figure 4b. Contrast-enhanced helical CT images obtained in a 63-year-old male patient 1 year after myocardial revascularization show that contrast medium uptake in the muscle flap still is good, despite atrophy to a thickness of 0.6 cm. Fine projections of contrast medium (arrows) toward the myocardium are seen on both (a) transverse and (b) coronally reconstructed sections and have been interpreted as evidence of vascular connections.
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Figure 5. Graph shows the mean values of time-dependent atrophy of the transplanted skeletal muscle flap in all patients postoperatively (post-op), at 6 months, and at 12 months. Error bars refer to SD.
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Figure 6. Graph shows the stress test results obtained in all patients (P1-P10) preoperatively (black bars), at 6 months (white bars), and at 12 months (gray bars).
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Copyright © 2000 by the Radiological Society of North America.
