title: Laser fluorescence angiography reveals perfusion defects in retrograde cardioplegia.
abstract: BACKGROUND
  Adequate perfusion of the right ventricle with retrograde cardioplegia has always been questioned. However, clinical studies suggested sufficient protection and, up to now, intraoperative assessment of cardioplegia distribution has been difficult.
  
  
  METHODS
  As a pilot study in 14 patients, we used indocyanine green laser fluorescence angiography (ICGLA) to assess vascular and myocardial perfusion of different areas of the right anterior ventricular wall. Regions of interest were analyzed quantitatively using a new software package.
  
  
  RESULTS
  ICGLA allowed rapid and reliable visualization of cardioplegic flow and distribution. Retrograde cardioplegia revealed perfusion defects in the territory of the right anterior cardiac veins when compared to antegrade delivery and to areas close to the left anterior descending vein(s), confirmed by quantitative analyses of maximal fluorescence intensity. Five patients were excluded from quantitative analyses. The learning curve, pitfalls, limitations and special image details are described.
  
  
  CONCLUSIONS
  A larger study is necessary to examine the relevance of perfusion defects to metabolic changes in affected myocytes and to global right ventricular function.
authors.affiliation: Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY, USA. Hgorki@aol.com
authors.forename: H
authors.initials: H
authors.lastname: Gorki
authors.forename: N C
authors.initials: NC
authors.lastname: Patel
authors.forename: L
authors.initials: L
authors.lastname: Balacumaraswami
authors.forename: J B
authors.initials: JB
authors.lastname: Pillai
authors.forename: V A
authors.initials: VA
authors.lastname: Subramanian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005451:Fluorescein Angiography / Q000379:methods*; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000379:methods*; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D007208:Indocyanine Green; D007834:Lasers; D008875:Middle Aged; D010477:Perfusion / Q000009:adverse effects / Q000379:methods*; D016278:Ventricular Function, Right
chemical_list: D007208:Indocyanine Green