Noninvasive Assessment of Off-Pump Coronary Artery Bypass Surgery by 16-Channel Multidetector-Row Computed Tomography Masato Yamamoto, MD, Fumiko Kimura,

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Noninvasive Assessment of Off-Pump Coronary Artery Bypass Surgery by 16-Channel Multidetector-Row Computed Tomography Masato Yamamoto, MD, Fumiko Kimura, MD, Hiroshi Niinami, MD, Yuji Suda, MD, Eiko Ueno, MD, Yasuo Takeuchi, MD The Annals of Thoracic Surgery Volume 81, Issue 3, Pages 820-827 (March 2006) DOI: 10.1016/j.athoracsur.2005.08.069 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 A 70-year-old man who had sequential grafting (RIMA to D1 to LAD) and LIMA to OM anastomosis. (A) Multidetector-row computed tomography (MDCT) volume-rendering image in the left anterior oblique projection showing no sequential anastomosis stenosis (white arrow), metallic clip (white arrowhead) not influencing the evaluation of anastomosis. His heart rate was 66 beats per minute at the time of MDCT examination. (B) Selective bypass graft angiography (SGA) image in 60-degree left anterior oblique projection showing no sequential anastomoses stenosis (white arrow). (D1 = first diagonal branch; LAD = left anterior descending artery. LIMA = left internal mammary artery; OM = obtuse marginal branch; RIMA = right internal mammary artery.) The Annals of Thoracic Surgery 2006 81, 820-827DOI: (10.1016/j.athoracsur.2005.08.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 A 70-year-old woman who had arteriosclerosis of RA graft (RIMA to RA, RA to OM to PL to PD) and LIMA to LAD anastomosis. (A) Multidetector-row computed tomography (MDCT) volume-rendering image in 148-degree left anterior oblique projection showing RIMA to I-composite graft of RA; RA to OM and RA to PL (white arrow) were patent and had no significant stenosis of graft anastomosis; RA to PD showed 100% occlusion (white dotted arrow). Her heart rate was 83 beats per minute at the time of MDCT examination. (B) Selective bypass graft angiography (SGA) image in 30-degree right anterior oblique projection showing same findings of MDCT volume-rendering image. (LAD = left anterior descending artery; LIMA = left internal mammary artery; OM = obtuse marginal branch; PD = posterior descending branch; PL = posterolateral branch; RA = radial artery; RIMA = right internal mammary artery.) The Annals of Thoracic Surgery 2006 81, 820-827DOI: (10.1016/j.athoracsur.2005.08.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 A 78-year-old man who had sequential grafting (LIMA to PL2 to PL1). (A) Multidetector-row computed tomography (MDCT) volume-rendering image in 148-degree left anterior oblique projection showing occluded proximal LIMA before PL2 anastomosis, but no sequential anastomosis stenosis (PL2 to LIMA and LIMA to PL1) like coronary–coronary bypass (white arrow). His heart rate was 67 beats per minute at the time of MDCT examination. (B) Selective bypass graft angiography (SGA) showing in 0-degree left anterior oblique projection very narrow LIMA (white dotted arrow) without demonstrating LIMA to PL2 and PL1 anastomosis because of competing counter blood flow from native left coronary artery. (C) Left coronary angiography image in 30-degree right anterior oblique projection showing retrograde enhanced LIMA (white dotted arrow) from PL2 and no sequential anastomosis stenosis from PL2 to LIMA and LIMA to PL1 (white arrow). (LIMA = left internal mammary artery; PL1 = first posterolateral branch; PL2 = second posterolateral branch.) The Annals of Thoracic Surgery 2006 81, 820-827DOI: (10.1016/j.athoracsur.2005.08.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 A 66-year-old man who had sequential grafting (RGEA to PD1 to PD2). (A) Multidetector-row computed tomography (MDCT) volume-rendering image showing no sequential anastomosis stenosis (RGEA to PD1 and RGEA to PD2 [white arrow]). Metallic clip artifact (white arrowhead) obscures distal native coronary artery after distal RGEA graft anastomosis. His heart rate was 80 beats per minute at the time of MDCT examination. (B) Multidetector-row computed tomography multiplanar reformatted image also showing no sequential anastomosis stenosis (RGEA to PD1 and RGEA to PD2 [white arrow]). Metallic clip artifact (white arrowhead) obscures distal native coronary artery as shown on the volume rendering image. (C) Selective bypass graft angiography (SGA) image in 30-degree right anterior oblique projection showing no sequential anastomosis stenosis (RGEA to PD1 and RGEA to PD2 [white arrow]). (PD1 = first posterior descending branch; PD2 = second posterior descending branch; RGEA = right gastroepiploic artery.) The Annals of Thoracic Surgery 2006 81, 820-827DOI: (10.1016/j.athoracsur.2005.08.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions