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Intraoperative epicardial ultrasound probe for visualization of embedded coronary arteries: a novel approach
Sudarshan Setty1, Ricardo Bello, Jonathan D Leff
11Montefiore Medical Center, Bronx, NY, USA.
Insights
Identifying embedded coronary arteries during cardiac revascularization is challenging. A high-frequency epicardial ultrasound probe effectively located these arteries in two cases, improving surgical precision.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
Background:
- Identifying coronary anatomy during cardiac revascularization can be difficult, especially with intramyocardial coronary arteries.
- Preoperative coronary angiography is useful but cannot always resolve intraoperative challenges.
Observation:
- Traditional methods like probing and intraoperative angiography have limitations.
- Previous studies explored epicardial echocardiography for off-pump procedures.
Findings:
- A high-frequency epicardial ultrasound probe successfully identified embedded coronary arteries in two patients undergoing on-pump cardiac revascularization.
- A technique involving sequential antegrade and retrograde cardioplegia administration aided in locating the arteries.
Implications:
- Epicardial ultrasound offers a valuable tool for intraoperative identification of challenging coronary anatomy.
- This technique can potentially reduce surgical dissection time and complications during revascularization.
Abstract:
The identification of coronary anatomy at the time of cardiac revascularization can be problematic. Preoperative studies (ie, coronary angiography) can aid in the mapping of the coronary anatomy. However, there remain a select few patients with intramyocardial coronaries that provide challenges for surgical dissection during revascularization. Probing the visible portion of the coronary artery, intraoperative cine angiography, thermal angiography, and epicardial Doppler probes have been used to identify the coronary anatomy intraoperatively. Aggressive surgical maneuvers can result in damage and increased time on cardiopulmonary bypass. Previous studies have used epicardial echocardiography on patients undergoing off-pump coronary artery bypass grafting. We report 2 cases in patients undergoing cardiac revascularization on cardiopulmonary bypass where the use of a high-frequency epicardial ultrasound probe facilitated the identification of the embedded coronary arteries. We describe a technique of using antegrade and retrograde cardioplegia administration sequentially to locate the coronary arteries. Easy availability and familiar technology make the epicardial Doppler probe an attractive tool for the identification of embedded coronary arteries.
