The Hemodynamic Study Of The Two Ends (Proximal And Distal) Of IMA And Its Clinical Application

Owing to its superior anatomic position.the internal mammary artery (IMA) has been popularly used in coronary artery myocardial revascularization since 1968.The series studies on its histology,histochemistry,immunohistochemistry,morphology and hemodynamics have shown that the IMA has many advantages such as: it has thin intima and endothelium-derived relaxing factor (EDRF); it has fine compliance and is free from arteriosclerosis; it is neither easy to form thrombus nor to be arteriostenosis again after coronary bypass operation.Both the early and late rate of unobstruct in patients with this method are higher than that with vein bypass.In order to reduce the anastomotic stoma tension .some authors proposed that the coronary artery myocardial revascularization could be gained by means of retrograde IMA flow. So far, this theory has been only proved to be feasible in animal experiments:Folts(1981)made myocardial revascularization of the canine circumflex coronary artery by retrograde IMA flow without cardiopulmonary bypass.The result showed that the retrograde flow of the IMA was adequate to maintain the circumflex bed.and the dogs could survive for 9 months to 3 years.Wang zheng(1987)made the anastomosis with the retrograde flow of the IMA to the right coronary artery of dogs.There was no significant difference between experimental groups and controled proximal group in early and late survival rates .Fujino(1976) was the first plastic surgeon who used the IMA as the recipient artery in breast reconstruction with superior gluteal microvascular free flap.Blondeel et al (1994) made breast reconstruction with the free bilateral deep inferior epigastric perferator flap anastomosed to the IMA by end-end and end-side in one woman with a vertical infraumbilical scar.Exciting yet satisfactory result was obtained They regarded their technique as "refinement and announced that application of IMA made the breast reconstruction "a great forward".But it is technuque demending and complex.Up to now.there has been no report on using the two ends of the IMA (proximal and distal) in coronary artery myocardiac revascularization and breast reconstruction.The aims of the study are to approach the hemodynamic changes at the two ends (proximal and distal) of IMA ,so as to verify the value of retrograde flow of IMA used as one of the supplying arteries and develop a new method in applying IMA in breast reconstruction.This study was carried out in the following three aspects: Anatomic study:Based on anatomic study on 20 sides of 10 cadavers.we find out that:1)The IMA is attachment with the subclavian artery.along the sternum by the intercostal arteries to the aorta,divided into two ends at the sixth intercostal space as the deep superior epigastric and...