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[Intraoperative fiber optic angioscopy during cardiovascular surgery]
S Ishimaru1, A Hakoshima, K Osada
1Department of Surgery, Tokyo Medical College, Japan.
Insights
Intraoperative angioscopy revealed critical aortic valve regurgitation affecting cardioplegia delivery and demonstrated the need for specific infusion pressures. This technique also aided in visualizing successful thromboendarterectomy and evaluating deep vein thrombosis complications.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Context:
- Intraoperative angioscopy offers direct visualization during cardiovascular procedures.
- Clinical experience highlights its utility and limitations in real-time surgical guidance.
Purpose:
- To investigate the clinical usefulness and limitations of intraoperative angioscopy in cardiovascular surgery.
- To assess the impact of angioscopy on procedural decisions and outcomes.
Summary:
- Angioscopy identified significant cardioplegic solution leakage via aortic regurgitation at pressures below 10 mmHg, indicating a need for >20 mmHg aortic pressure for myocardial protection.
- It enabled accurate fixation of intimal flaps after thromboendarterectomy for arteriosclerosis obliterans.
- Evaluation of deep vein thrombosis post-thrombectomy revealed persistent iliac compression, underscoring the need for comprehensive assessment.
- Saline flushing effectively clears the cardiovascular lumen, but fluid overload risk necessitates careful monitoring during prolonged observation.
Impact:
- Optimizes cardioplegia delivery strategies for enhanced myocardial protection.
- Improves the precision and success rate of thromboendarterectomy procedures.
- Aids in the complete assessment of vascular conditions like deep vein thrombosis.
- Enhances intraoperative decision-making and patient safety in complex cardiovascular interventions.
Abstract:
The usefulness and limitation of intraoperative angioscopy in the field of cardiovascular surgery were investigated based on our clinical experience. Considerable leakage of cardioplegic solution through the aortic valve due to valve regurgitation was angioscopically demonstrated when the infusion pressure in the aortic root was less than 10 mmHg. This indicates that the cardioplegia must be infused with an aortic pressure of above 20 mmHg for appropriate myocardial protection. After thromboendarterectomy on the arteriosclerosis obliterans, fixation with the edge of the residual intimal flap to the arterial wall was performed correctly under direct visualization. The status of thrombus organization in deep vein thrombosis was evaluated. Even after complete thrombectomy, iliac compression was still demonstrated. Blood in the cardiovascular lumen can be easily cleaned by saline flushing. However, careful attention to fluid overloading must be employed when the observation period is prolonged.