GIÁ TRỊ CỦA SIÊU ÂM DOPPLER ĐÁNH GIÁ ĐỘNG MẠCH VÚ TRONG TRƯỚC PHẪU THUẬT BẮC CẦU ĐỘNG MẠCH VÀNH

Abstract

Background: The internal mammary artery (IMA), particularly the left internal mammary artery (LIMA), has long been considered the conduit of choice in coronary artery bypass grafting (CABG) due to its resistance to atherosclerosis and superior long-term patency. However, preoperative hemodynamic assessment of the IMA is not yet routinely performed in clinical practice. Objective: To assess the morphological and hemodynamic characteristics of the bilateral internal mammary arteries using preoperative Doppler ultrasound in patients scheduled for coronary artery bypass grafting, with the aim of providing quantitative data to support preoperative evaluation and guide conduit selection. Methods: A retrospective case series was conducted on 55 patients indicated for CABG, who underwent Doppler ultrasound of both IMAs at Cho Ray Hospital from August to December 2024. The parameters assessed included vessel diameter, peak systolic velocity (PSV), peak flow volume (FV max), and mean flow volume (FV mean). Results: Among the 55 patients analyzed, the majority were male (72.7%), with a mean age of 60.1 ± 7.1 years—consistent with the high-risk demographic commonly indicated for CABG. Preoperative Doppler assessment showed that the right IMA (RIMA) demonstrated significantly superior hemodynamic parameters compared to LIMA, including larger diameter, higher PSV, and higher FV mean (all statistically significant). Although FV max was also higher in RIMA than LIMA, the difference was not statistically significant. Gender-based analysis revealed no significant differences in any Doppler parameters, indicating that sex does not influence the hemodynamic profile of the IMA. Notably, both PSV and FV mean values for RIMA and LIMA exceeded previously reported prognostic thresholds, suggesting favorable perfusion capacity and the potential for increased flow post-anastomosis. Conclusion: Doppler ultrasound is a valuable, noninvasive and feasible preoperative assessment method for assessing the hemodynamic characteristics and size of bilateral internal mammary arteries before coronary artery bypass grafting. The results of the study showed that the right internal mammary artery had superior hemodynamic parameters and diameter compared to the left internal mammary artery, while both internal mammary artery branches achieved good physiological values. In terms of hemodynamic and size, the right internal mammary artery can replace the left internal mammary artery in the bridge into the anterior descending artery.