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To assess the role of high-dose up to 0.84 mg/kg during 10 minutes) dipyridamole echocardiographic testing in the evaluation of coronary artery bYPass graft patency early after surgery, 18 consecutive patients with angina underwent dipyridamole echocardiography and coronary angiography before and 7 to 10 days after bypass surgery. Coronary angiography showed 2- or 3-vessel disease in 7 and 11 patients, respectively. A total of 53 bypass grafts were performed. Before bypass surgery 14 patients had a positive and 4 a negative test result. No complication occurred during the test early after surgery. Of the 14 patients with positive dipyridamole echocardlegraphic results before surgery, 10 had negative and 4 had positive results after surgery. All 4 patients had negative results before and after surgery. in the 4 patients with positive results after dipyridamole echocardlographic testing before and after bypass surgery, dipyridamole time increased from 5.8 +/- 5 to 9.3 +/- 0.9 minutes (p = 0.3) after the procedure and wall motion score index at peak dipyridamole changed from 1.55 +/- 0.2 to 1.28 +/- 0.3 (p = 0.05). Forty-nine of S3 grafts were patent as seen on angiography. Dipyridamole echocardlographic results were positive in 4 of 5 patients who had at least 1 obstructed graft or native vessel obstructed distal to bypass graft insertion. The remaining patient had diagnostic electrocardiogardiographic changes during dipyridamole infusion without wall motion abnormalities. Dipyridamole echocardiographic results were negative in all 13 patients who had complete revascularization. In the 4 patients with positive test results, the procedure correctly identified the localization of the diseased bypass graft. These data suggest that (1) dipyridamole echocardiography can be easily and safely performed after coronary artery bypass graft surgery, (2) there is an excellent correlation between the functional improvement assessed by dipyridamele echocardiography testing and anatomic results of coronary artery bypass surgery, and (3) it reliably detects and identifies diseased bypass grafts. (Am J Cardiol 1991;67:133-136), When the arteries supplying the heart muscle with blood (coronary arteries) become blocked, resulting in a diminution in the cardiac blood supply, several strategies are available for restoring the patency of the vessels. Coronary artery bypass grafting (CABG) is a commonly used technique in which a healthy blood vessel is taken from elsewhere in the body and used to bypass the occluded coronary artery. It is useful to know in the immediate postoperative period whether or not the graft is successful. Standard means of assessing coronary blood flow, such as exercise echocardiography, are dangerous to perform on CABG patients. An alternative to exercise is administration of the drug dipyridamole, which has a pharmacological action on the cardiovascular system quite similar to that of exercise, but without many of the dangers attendant upon vigorous physical exertion. To assess the utility of high-dose dipyridamole echocardiography in the evaluation of coronary blood flow, 18 patients with angina pectoris (chest pain resulting from diminished blood flow to the heart) were evaluated using this technique both prior to and 7 to 10 days after CABG surgery. Presurgery evaluation showed that all patients had either two- or three-vessel disease, and a total of 53 bypass grafts were performed. Angiography (a very accurate, but invasive radiological technique for viewing coronary blood flow) results correlated very highly with the findings of the noninvasive dipyridamole tests. This indicates that dipyridamole echocardiography is a safe, easy technique for use following CABG (and potentially other types of cardiovascular) surgery and has a high degree of accuracy and specificity. (Consumer Summary produced by Reliance Medical Information, Inc.)