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Intra-operative diagnostics of surgical stenoses of coronary arteries

Bakoulev Scientific Center for Cardiovascular Surgery, Rublevskoe Shosse 135, Moscow 121552, Russia

Thermal coronary angiography in pediatric coronary artery bypass grafting

The guarantee for the success of the coronary artery bypass grafting (CABG) both in pediatric and adult practice is a good anastomotic patency. According to the literature, the coronary bypass patency can be established intra-operatively by the following diagnostic methods: standard X-ray angiography, intra-operative imaging system (SPY) using laser fluorescent angiography and thermal coronary angiography. The last one was applied by the authors of the publication [1]. We congratulate the authors on the successful intra-operative detection of anastomotic stricture of left internal thoracic artery and the left anterior descending coronary artery which helped to remove one of the risky complications in proper time. For the first time Intra-operative Imaging system (SPY) using laser fluorescent angiography [2, 3] was applied in the Bakoulev Centre of Cardiovascular Surgery in December, 2006 [4].

Intra-operative laser fluorescent-dye graft angiography with the use of IC Green (indicyanine green dye) provides an excellent real-time imaging of coronary arteries and shunts with speed of 30 shots per second. According to the data, the dye was entered into the central vein, cardiopulmonary bypass apparatus or directly in coronary artery shunts [5, 6].

At this moment the experience of investigation of this method of Intra-operative angiography in our Centre includes 11 patients. In 8 cases, laser fluorescent angiography was used after correction of a congenital heart disease in children at from the age of 7 days up to 3 months: in 3 patients after correction of anomalous left coronary artery from the pulmonary artery and in 5 patients with complete transposition of the great arteries after arterial switch operation. In the other 3 cases, the method was used for evaluation of coronary bypass patency of adults with coronary heart disease (CHD). According to the analysis of all cases the received intra-operative angiograms had precise and accurate images of coronary arteries and shunts; myocardial perfusion defects were not revealed. From our point of view, the most optimal place of introduction of dye at laser fluorescent angiography is the right auricle.

Thus, introduction in clinical practice of intra-operative diagnostic methods of stenoses of coronary arteries (thermal angiography, laser fluorescent angiography) opens new opportunities for early diagnostics of complications and improvements of the results after surgical operations.

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1. Miyamoto T, Miyaji K, Ishii M, Tashiro T. Thermal coronary angiography in pediatric coronary artery bypass grafting. Interact CardioVasc Thorac Surg 2008; 7:161–163.[Abstract/Free Full Text]
2. Taggart DP, Choudhary B, Anastasiadis K, Abu-Omar Y, Balacumaraswami L, Pigott DW. Preliminary experience with a novel intraoperative flourescence imaging technique to evaluate the patency of bypass grafts in total arterial revascularization. Ann Thorac Surg Mar 2003; 75:870–873.[Abstract/Free Full Text]
3. Balacumaraswami L, Abu-Omar Y, Choudhary B, Pigott D, Taggart DP. A comparison of transit-time flowmetry and intraoperative fluorescence imaging for assessing coronary artery bypass graft patency. J Thorac Cardiovasc Surg 2005; 130:315–320. (2005).[Abstract/Free Full Text]
4. Medical alphabet of radiology . Innovative method of intra-operative visualization of coronary arteries. 2006;19–20.
5. Takahashi M, Ishikawa T, Higashidani K, Katoh H. SPYTM: an innovative intra-operative imaging system to evaluate patency during off-pump coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2004; 3:479–483.[Abstract/Free Full Text]
6. Desai ND, Miwa S, Kodama D, Cohen G, Christakis GT, Goldman BS, Baerlocher MO, Pelletier MP, Fremes SE. Improving the quality of coronary bypass surgery with intraoperative angiography. J Am Coll Cardiol 2005; 46:1521–1525.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leo A. Bockeria Permission Requests Google Scholar Articles by Bockeria, L. A. Articles by Venglinskaya, T. M. PubMed Articles by Bockeria, L. A. Articles by Venglinskaya, T. M. Related Collections Related Article