Assessment of the Coronary Sinus Diameter after Successful Coronary Artery Bypass Surgery: A Preliminary Echocardiographic Cardiac Perfusion Study

Document Type: Original Article

Authors

Department of Cardiology, Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran.

Abstract

Background: There is a growing interest in noninvasive methods for the assessment of sufficient
coronary flow after coronary artery bypass graft surgery (CABG) by transthoracic
echocardiography (TTE).
Methods: We performed this study to evaluate the coronary sinus diameter (CSD), as a confident
marker of the coronary blood flow, by TTE among patients undergoing CABG. A total of 104
elective CABG patients with double, triple, or more coronary artery diseases were enrolled in
this cross-sectional study. Four patients were lost to follow-up because of poor
echocardiographic window or death. One day before and 7 days after CABG, all the patients
underwent TTE.
Results: The mean CSD was calculated by averaging the diameters of the middle and terminal
segments of the coronary sinus. The left ventricular ejection fraction (LVEF) was calculated
using the Simpson methods. The CSD in the middle (11.1%; P < 0.0001) and terminal (10.1%;
P < 0.0001) segments was significantly increased after CABG among all the patients.
Additionally, the diameter change was most prominent among those with triple vessel disease.
Similarly, a significant increase was observed in the mean CSD after CABG (11.3%;
P < 0.0001).
Conclusions: No significant changes were observed after CABG with respect to the LVEF in the first
postoperative week. The findings showed that the TTE-determined CSD could be a potential
surrogate for sufficient coronary perfusion and graft patency after CABG.

Keywords


1. Tan ES, van der Meer J, Jan de Kam P,
Dunselman PH, Mulder BJ, Ascoop CA, et al.
Worse clinical outcome but similar graft
patency in women versus men one year after
coronary artery bypass graft surgery owing to
an excess of exposed risk factors in women.
CABADAS. Research Group of the
Interuniversity Cardiology Institute of The
Netherlands. Coronary Artery Bypass graft
occlusion by Aspirin, Dipyridamole and
Acenocoumarol/ phenoprocoumon Study.
Journal of the American College of Cardiology.
1999; 34(6):1760-8.
2. Bates ER, Aueron FM, Legrand V, LeFree MT,
Mancini GB, Hodgson JM, et al. Comparative
long-term effects of coronary artery bypass
graft surgery and percutaneous transluminal
coronary angioplasty on regional coronary flow
reserve. Circulation. 1985; 72(4): 833-9.
3. Chatterjee K, Matloff JM, Swan HJ, Ganz W,
Sustaita H, Magnusson P, et al. Improved
angina threshold and coronary reserve
following direct myocardial revascularization.
Circulation. 1975 ; 52(2 Suppl): I81-92.
4. Crone-Munzebrock W, Kupper W, Montz R,
Darup J, Bleifeld W. [Comparison of
myocardial scintigraphy, myocardial lactate
extraction and coronary sinus blood flow before
and after coronary artery bypass surgery
(author’s transl)]. Zeitschrift fur Kardiologie.
1982; 71(2): 87-92.
5. Siostrzonek P, Kranz A, Heinz G, Rodler S,
Gossinger H, Kreiner G, et al. Noninvasive
estimation of coronary flow reserve by
transesophageal Doppler measurement of
coronary sinus flow. The American journal of
cardiology. 1993 Dec 1;72(17):1334-7.
6. Johnson LW, Krone R. Cardiac catheterization
1991: a report of the Registry of the Society for
Cardiac Angiography and Interventions
(SCA&I). Catheterization and cardiovascular
diagnosis.
7. Ng DW, Vlachonassios K, Nimalasuriya AR,
Nguyen VT, Wijesekera C, Khan A, et al.
Usefulness of transthoracic echocardiography
in demonstrating coronary blood flow after
coronary artery bypass grafting. The American
journal of cardiology. 2004 Apr 1;93(7):923-5.
8. Kronzon I, Tunick PA, Jortner R, Drenger B,
Katz ES, Bernstein N, et al. Echocardiographic
evaluation of the coronary sinus. Journal of the
American Society of Echocardiography :
official publication of the American Society of
Echocardiography. 1995 Jul-Aug;8(4):518- 26.
9. Goldman S, Henry R, Friedman MJ, Ovitt T,
Rosenfeld A, Salomon N, et al. Increased
regional myocardial perfusion after
intracoronary papaverine in patients after
coronary artery bypass grafting. The Journal of
thoracic and cardiovascular surgery. 1982
Apr;83(4):563-8.
10. D’Cruz IA, Shirwany A. Update on
echocardiography of coronary sinus anatomy
and physiology. Echocardiography (Mount
Kisco, NY). 2003 Jan;20(1):87-95.
11. Ishimitsu T, Sakamoto T, Hada Y, Amano K,
Yamaguchi T, Takenaka K, et al. [Detection of
coronary sinus by parasternal two-dimensional
echocardiography and the clinical significance].
Journal of cardiography. 1983 Sep;13(3):675-
83.


12. Gunes Y, Guntekin U, Tuncer M, Kaya Y,
Akyol A. Association of coronary sinus
diameter with pulmonary hypertension.
Echocardiography (Mount Kisco, NY). 2008
Oct;25(9):935-40.
13. Kizilkan N, Davutoglu V, Erbagci H, Karagoz
A, Akcay M, Sari I, et al. Coronary sinus
dilatation. A simple additional 7
echocardiographic indicator of severe
rheumatic mitral and tricuspid valve disease.
Saudi medical journal. 2010 Feb;31(2):153-7 .
14. D’Cruz IA, Johns C, Shala MB. Dynamic cyclic
changes in coronary sinus caliber in patients
with and without congestive heart failure. The
American journal of cardiology.1999 Jan
15;83(2):275-7, A6.
15. Xia Zhi Zheng, Bin Yang, Jing Wu. Comparison
of the Efficacy of Conventional
Echocardiographic Parameters in the Diagnosis
of Significant Coronary Artery Stenosis. Iran J
Radiol. 2015 Jan; 12(1): e11405.