title: Intraoperative epicardial ultrasound probe for visualization of embedded coronary arteries: a novel approach.
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.
authors.affiliation: 1Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Sudarshan
authors.initials: S
authors.lastname: Setty
authors.forename: Ricardo
authors.initials: R
authors.lastname: Bello
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Leff
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D015150:Echocardiography, Doppler / Q000379:methods; D006324:Heart Arrest, Induced / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D010496:Pericardium / Q000000981:diagnostic imaging
keywords: cardiac surgery; cardiopulmonary bypass; coronary artery bypass grafting; coronary artery bypass surgery; intraoperative assessment