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[Intraoperative contrast echocardiography using sonicated iopromide (Ultravist 370) for imaging the post-bypass
Insights
Intraoperative myocardial echocardiography using contrast enhancement provides a safe and feasible method for visualizing and quantifying regional blood flow after coronary artery bypass surgery, improving myocardial revascularization assessment.
Area of Science:
- Cardiology
- Medical Imaging
- Surgical Assessment
Background:
- Inadequate myocardial revascularization necessitates intraoperative evaluation of regional myocardial perfusion.
- Current bypass flow measurements are limited to epicardial blood flow assessment.
Purpose of the Study:
- To analyze regional graft-dependent myocardial blood flow intraoperatively.
- To evaluate the feasibility and safety of intraoperative myocardial contrast echocardiography.
Main Methods:
- Echocardiographic short-axis view of the left ventricle was performed in 11 patients undergoing coronary artery bypass surgery.
- 2 ml of sonicated lopromid (Ultravist 370) was injected into 14 vein grafts.
- Contrast enhancement and decay halftimes (T/2) were measured using videodensitometry and compared to electromagnetic flow (EMF) rates.
Main Results:
- Contrast enhancement in myocardial regions was clearly visible with no reported side-effects.
- Contrast decay halftimes (T/2) ranged from 2.1 to 6.9 s (mean 4.1 ± 1.5 s).
- T/2 values did not correlate with EMF rates (55-100 ml/min, mean 80 ± 16 ml/min).
Conclusions:
- Intraoperative myocardial echocardiography is a safe and feasible technique.
- This method allows for on-line visualization and off-line quantitation of regional myocardial perfusion.
- It offers practical impact in minimizing inadequate myocardial revascularizations.
Abstract:
In order to minimize the rate of inadequate myocardial revascularizations, an intraoperative evaluation of regional myocardial perfusion could have practical impact. Current bypass flow measurements have inherent limitations and can determine only epicardial blood flow. To analyze regional graft-dependent myocardial blood flow an echocardiographic short-axis view of the left ventricle was performed intraoperatively in 11 patients undergoing elective coronary artery bypass surgery. After injection of 2 ml of sonicated lopromid (Ultravist 370) into 14 vein grafts, contrast enhancement in the corresponding myocardial regions was clearly visible, no side-effects occurred. Contrast decay halftimes (T/2) were determined by computer-assisted videodensitometry and compared to electromagnetic flow (EMF) rates, which were measured immediately before. T/2 ranged from 2.1 to 6.9 (mean 4.1 +/- 1.5) s and did not correlate to the EMF-rates of 55 to 100 (mean 80 +/- 16) ml/min. Thus intraoperative myocardial echocardiography is a safe and feasible method which allows on-line visualization and off-line quantitation of regional myocardial perfusion intraoperatively.