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Vein Graft Function Improvement after Percutaneous Intervention: Evaluation with MR Flow Mapping¹

¹ From the Departments of Cardiology (S.E.L., H.W.V., J.W.J., E.E.v.d.W.), Radiology (S.E.L., H.J.L., A.d.R.), and Medical Statistics (A.H.Z.), Leiden University Medical Center, Albinusdreef 2, C5-P, 2300 RC Leiden, the Netherlands; and the Interuniversity Cardiology Institute of the Netherlands, Utrecht (S.E.L., A.d.R., E.E.v.d.W.). Received March 29, 2002; revision requested June 11; final revision received December 30; accepted January 2, 2003. S.E.L. supported by grant 97.173 from the Netherlands Heart Foundation. Address correspondence to E.E.v.d.W. (e-mail: e.e.van_der_wall@lumc.nl).

View larger version (153K): [in a new window]   Figure 1. A, Conventional coronary angiogram (right anterior oblique view) of a sequential vein graft to the left circumflex coronary artery in a 61-year-old man shows a 74% origin stenosis (arrow) in the graft. Cath = catheter, sw = sternal wire, vc = vascular clip. B, Multiplanar reconstruction of navigator-gated three-dimensional MR angiographic data (repetition time msec/echo time msec, 7.1/1.9; pulses per shot, 10; field of view, 360 mm; rectangular field of view, 75%; matrix, 512 x 512; scan percentage, 70%; flip angle, 30°; section thickness, 3 mm reconstructed to 1.5 mm; imaging time, 15-20 minutes) confirms the origin stenosis (arrow). Ao = ascending aorta, LV = left ventricle, PA = pulmonary artery. C, D, Oblique sagittal flow MR images (11.0/4.6; field of view, 200 x 100 mm; matrix, 128 x 60; flip angle, 20°; temporal resolution, 23 msec; velocity encoding, 75 cm/sec; imaging time, 20 heartbeats) obtained, C, at baseline and, D, during stress. Images on the left are modulus images with anatomic information; images on the right are phase images with velocity information. A detail of the graft cross section is depicted in the upper left corner of each image. Arrows = cross section of the graft depicted in A and B. In addition and more anterior to a cross section of the stenotic vein graft, the cross section of a left internal mammary artery graft to the left anterior descending coronary artery can be seen.

View larger version (188K): [in a new window]   Figure 2. Images obtained in the same patient as in Figure 1. A, Conventional coronary angiogram (right anterior oblique view) obtained during PCI shows the inflated balloon (b) and stent. Cath = catheter. B, Conventional coronary angiogram (right anterior oblique view) obtained immediately after PCI shows that the graft lumen has normalized. Cath = catheter. C1, C2, C3, Transverse MR angiographic sections (7.1/1.9; pulses per shot, 10; field of view, 360 mm; rectangular field of view, 75%; matrix, 512 x 512; scan percentage, 70%; flip angle, 30°; section thickness, 3 mm reconstructed to 1.5 mm; imaging time, 15-20 minutes) obtained after PCI show the course of the vein graft to the left circumflex coronary artery (arrowhead) and the left internal mammary artery graft (arrow). Ao = ascending aorta, PA = pulmonary artery, sw = artifact from sternal wire, * = artifact from stent. D, E, Oblique sagittal flow MR images (11.0/4.6; field of view, 200 x 100 mm; matrix, 128 x 60; flip angle, 20°; temporal resolution, 23 msec; velocity encoding, 75 cm/sec; imaging time, 20 heartbeats) obtained after PCI, D, at baseline and, E, during stress show increased signal intensity reflecting improved flow. Images on the left are modulus images with anatomic information; images on the right are phase images with velocity information. A detail of the graft cross section is depicted in the upper left corner of each image. Arrowheads = cross section of the graft depicted in A and B. In addition and more anterior to a cross section of the stenotic vein graft, the cross section of a left internal mammary artery graft to the left anterior descending coronary artery can be seen.

View larger version (27K): [in a new window]   Figure 3. Graph shows four peak velocity-versus-time curves for the same vein graft as in Figures 1 and 2. The thin line with black circles () represents the baseline measurement before PCI; the thick line with black circles represents the stress measurement before PCI. The thin line with open circles () represents the baseline measurement after PCI; the thick line with open circles represents the stress measurement after PCI.

View larger version (30K): [in a new window]   Figure 4. Graph depicts changes in baseline APV (APVbase) and stress APV (APVstress) after PCI in each individual graft. The dots above number 1 represent data before PCI; the dots above number 2, data after PCI. MR flow mapping enables the detection of improved graft and/or recipient coronary artery function after PCI.

View larger version (26K): [in a new window]   Figure 5. Graphs reflect changes in mean baseline APV (APVbase), mean stress APV (APVstress), and mean velocity reserve (CFVR) in stenotic single vein grafts after PCI in comparison with pre-PCI values in these grafts. For comparison, reference values for nonstenotic single vein grafts are shown.