Intra-operative contrast echocardiography in coronary artery disease

Area of Science:

• Cardiovascular Surgery
• Diagnostic Imaging
• Myocardial Perfusion Imaging

Background:

• Intra-operative echocardiography is increasingly vital for assessing cardiac surgery outcomes.
• Myocardial contrast echocardiography (MCE) is a novel technique for evaluating regional myocardial blood flow and cardioplegia delivery.

Purpose of the Study:

• To evaluate the utility of MCE in coronary artery surgery.
• To demonstrate MCE's application in identifying hypoperfused segments, monitoring myocardial protection, and assessing graft patency.

Main Methods:

• MCE was utilized at three key stages: pre-cardiopulmonary bypass, during cardioplegic arrest, and post-operatively.
• Assessment of regional perfusion patterns, cardioplegia distribution, and graft patency was performed using MCE.

Main Results:

• MCE identified hypoperfused myocardial segments before bypass, enabling prioritized revascularization based on perfusion and collateral circulation.
• Real-time monitoring of cardioplegia distribution allowed for the identification of inadequately protected myocardial regions.
• Post-operative MCE assessed graft patency and the 'area at risk' for occlusion.

Conclusions:

• Intra-operative MCE provides novel, valuable information impacting surgical strategy in coronary artery surgery.
• The technique facilitates real-time assessment of myocardial protection and graft viability.
• Quantitative on-line data on myocardial blood flow using MCE is a desirable future implementation.