[HSF] Flow requirements in recent infarcts

[Nasser F. Abou'Seada]

I did ask such a question before to Tomas, master of measuring
intraoperative coronary blood flow. can anyone tell about the flow through
the LIMA in the first hours postop ? compared to the flow through a SVG
during the same period ? and what is really the required flow for a REAL
CRITICAL lesion- ischaemic myocardium ?

speaking objectively: if the LIMA flow is LOW in the first few hours post
revascularization, lower than the THRESHOLD flow required by the CRITICALLY
ischaemic LV, then apparently either the LV will not come up, or the lesion
was NOT REALLY CRITICAL. !

Having a patient with a CLAIMED CRITICAL LAD lesion, and inserting a LIMA to
LAD, with uneventful sequelae, strongly points out at a wrong diagnosis to
start with... !!!! ...

a trick that I have learnt is - in case I am really sure it is a critically
stenotic LAD- is to insert a straight foreward SVG-LAD, and a LIMA to
Diagonal, supplying the same territory, accounting for a long term perfusion
and at same time, not missing the required flow to reperfuse a critically
ischaemic myocardium.

IMHO, LIMA-LAD is the ideal procedure, in the consensus of a total arterial
revascularization. but still SVG do have a place, as a short term tide
over, especially in the occasion of a real critical ischaemic stenosis.

??? Any documented CRT as to the reverse ?


NFA

On 5/3/07, james le <jamesle2007 at yahoo.com> wrote:
>
>
>
> One my seniors always uses vein graft to LAD for acute  anterior MI
> patients going for emergency CABG .
> Accoarding to him blood flow requirements of infracted areas is high .
> I wish to know whether it is correct?
>
>
>
> --
> Nasser  F.  Abou'Seada,
> MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
> FICS,FISCVS,FSSRCTS,FHMS,MESC