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Updated: Jul 11, 2026
Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Image-guided quantification of cardioplegia delivery during cardiac surgery
Edward G Soltesz1, Rita G Laurence, Alec M De Grand
1Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Insights
A new noninvasive optical method using indocyanine green (ICG) allows real-time visualization and quantification of cardioplegia delivery during cardiac surgery. This technique helps assess myocardial perfusion and guides immediate corrective actions for improved patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Optical Diagnostics
Background:
- Adequate cardioplegia distribution is crucial for myocardial recovery after cardiopulmonary bypass.
- Current methods lack the ability to assess cardioplegia distribution during surgery.
- A real-time, noninvasive method is needed to evaluate cardioplegia delivery.
Purpose of the Study:
- To evaluate the feasibility of a novel noninvasive optical method for quantifying cardioplegia delivery.
- To enable instantaneous imaging of jeopardized myocardium during cardiac surgery.
- To allow immediate intraoperative corrective measures for improved cardiac function.
Main Methods:
- Development of a portable, intraoperative near-infrared (NIR) fluorescence imaging system.
- Utilizing exogenous NIR fluorophores for real-time visualization of cardiac functions.
- Employing indocyanine green (ICG) as an FDA-approved intravascular fluorophore.
Main Results:
- Demonstrated real-time assessment of cardioplegia delivery in a porcine model using ICG.
- ICG injection visualized segmental cardioplegia distribution in real-time.
- Simulated occlusions showed imaging defects correlating with poor delivery; videodensitometry quantified distribution.
Conclusions:
- Developed a novel, noninvasive, intraoperative technique for visual assessment of cardioplegia delivery.
- The technique allows for safe and easy evaluation of antegrade and/or retrograde cardioplegia.
- Offers potential to quantify segmental distribution, improving cardiac surgical procedures.
Background:
Homogenous distribution of cardioplegia delivered to the myocardium has been identified as an important predictor of post-cardiopulmonary bypass ventricular recovery and function. Presently, a method to determine adequate distribution of cardioplegia in patients during cardiac surgery does not exist. The goal of this study was to evaluate the feasibility of quantifying cardioplegia delivery using a novel, noninvasive optical method. Such a system would permit instantaneous imaging of jeopardized myocardium and allow immediate, intraoperative corrective measures.
Methods:
We have previously developed a portable, intraoperative near-infrared (NIR) fluorescence imaging system for use in large animal cardiac surgery that simultaneously displays color video and NIR fluorescent images of the surgical field. By introducing exogenous, NIR fluorophores, specific cardiac functions can be visualized in real-time.
Results:
In a porcine cardiopulmonary bypass model, we demonstrate that the FDA-approved intravascular fluorophore indocyanine green (ICG) permits real-time assessment of cardioplegia delivery. ICG was injected into an aortic root and/or transatrial coronary sinus catheter during delivery of crystalloid cardioplegia solution. Segmental distribution was immediately noted at the time of injection. In a subset of animals, simulated coronary occlusions resulted in imaging defects consistent with poor cardioplegia delivery and jeopardized myocardium. Videodensitometric analysis was performed on-line to quantify distribution to the right ventricle and left ventricle.
Conclusion:
We report the development of a novel, noninvasive, intraoperative technique that can easily and safely provide a visual assessment of cardioplegia delivery (antegrade and/or retrograde) and that offers the potential to quantify the relative segmental distribution during cardiac surgical procedures.