Management of Internal Mammary Artery Spasm

Ziadinov, Edam; Al-Kemyani, Nasser; Alsabti, Hilal

doi:10.4236/ijcm.2014.55042

Cited by 2 publications

(2 citation statements)

References 44 publications

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“…There are more than hundred reports in literature dedicated to pharmacological prevention of ITA spasm. 9 However until now there is no consensus regarding drug, its dosage and route of administration. The question remains unanswered though whether prevention is required in general.…”

Section: Discussionmentioning

confidence: 99%

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Use of nitroglycerin and verapamil solution by organ bath technique in preparation of left internal thoracic artery for coronary artery bypass surgery

Mohapatra

Mishra

Saxena

et al. 2017

Indian Heart Journal

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BackgroundThe aim of this prospective study was to compare the effect of application of nitroglycerin and verapamil solution (GV) by organ bath technique with other methods of applications and solutions on the free blood flow of LITA. The technique was not described for in situ graft before.MethodThe patients were randomly assigned to four groups: group I (n_32, GV solution by organ bath technique), group II (n_30, papaverine solution by organ bath technique), group III (n_29, topical GV solution) or group IV (n_29, topical papaverine solution). In each patient, pedicled LITA was harvested; thereafter applied with the randomized different methods and solutions. The free flow from the distal end of the divided LITA was measured for 15 s under controlled hemodynamic conditions after harvesting (Flow 1). The flow of LITA was measured again just prior to anastomosing the conduit (Flow 2).ResultThe mean blood flow in LITA was 56.2 ± 5.0 ml/min before application of solutions. After application, the mean blood flow in group I:102.3 ± 7.0 ml/min, in group II: 92.7 ± 3.4 ml/min, and in group III: 88.6 ± 2.2 ml/min and in group IV: 81.4 ± 2.1. Proportional increases in blood flow observed in group I (82.6%) > group II (65.1%) > group III (57.6) > group IV (44.8%) (p < 0.05).ConclusionsGV solution by organ bath technique is effective and superior in comparison to use of papaverine using organ bath technique or topical spray of GV or papaverine solution.

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Section: Discussionmentioning

confidence: 99%

“…7 Since then, many cardiac surgeons have used this drug to treat the spasm both of ITA and vein grafts. 9 This vasodilator can be used topically and intraluminally, but its solution is acid (pH 4.4–4.8) 13 when used in surgery. Acid solutions can cause damage to endothelium.…”

Section: Discussionmentioning

confidence: 99%

Use of nitroglycerin and verapamil solution by organ bath technique in preparation of left internal thoracic artery for coronary artery bypass surgery

Mohapatra

Mishra

Saxena

et al. 2017

Indian Heart Journal

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Effect of Type-2 Diabetes Mellitus on the Expression and Function of Smooth Muscle ATP-Sensitive Potassium Channels in Human Internal Mammary Artery Grafts

Rajkovic,

Peric,

Stanisic

et al. 2024

Pharmaceuticals

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Here we have shown for the first time altered expression of the vascular smooth muscle (VSM) KATP channel subunits in segments of the human internal mammary artery (HIMA) in patients with type-2 diabetes mellitus (T2DM). Functional properties of vascular KATP channels in the presence of T2DM, and the interaction between its subunits and endogenous ligands known to relax this vessel, were tested using the potassium (K) channels opener, pinacidil. HIMA is the most commonly used vascular graft in cardiac surgery. Previously it was shown that pinacidil relaxes HIMA segments through interaction with KATP (SUR2B/Kir6.1) vascular channels, but it is unknown whether pinacidil sensitivity is changed in the presence of T2DM, considering diabetes-induced vascular complications commonly seen in patients undergoing coronary artery bypass graft surgery (CABG). KATP subunits were detected in HIMA segments using Western blot and immunohistochemistry analyses. An organ bath system was used to interrogate endothelium-independent vasorelaxation caused by pinacidil. In pharmacological experiments, pinacidil was able to relax HIMA from patients with T2DM, with sensitivity comparable to our previous results. All three KATP subunits (SUR2B, Kir6.1 and Kir6.2) were observed in HIMA from patients with and without T2DM. There were no differences in the expression of the SUR2B subunit. The expression of the Kir6.1 subunit was lower in HIMA from T2DM patients. In the same group, the expression of the Kir6.2 subunit was higher. Therefore, KATP channels might not be the only method of pinacidil-induced dilatation of T2DM HIMA. T2DM may decrease the level of Kir6.1, a dominant subunit in VSM of HIMA, altering the interaction between pinacidil and those channels.

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Management of Internal Mammary Artery Spasm

Abstract: The article is dedicated to the management of internal mammary artery spasm intra-and postoperatively based on the accumulated evidence in the literature. It provides a stepwise decision algorithm for safely resolving the spasm and prevention of relapse.

Cited by 2 publications

References 44 publications

Use of nitroglycerin and verapamil solution by organ bath technique in preparation of left internal thoracic artery for coronary artery bypass surgery

Use of nitroglycerin and verapamil solution by organ bath technique in preparation of left internal thoracic artery for coronary artery bypass surgery

Effect of Type-2 Diabetes Mellitus on the Expression and Function of Smooth Muscle ATP-Sensitive Potassium Channels in Human Internal Mammary Artery Grafts

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