Intraoperative High-Frequency Epicardial Echocardiography in Coronary Revascularization: Locating Deeply Embedded Coronary Arteries

Hiratzka, Loren F.; McPherson, David D.; Brandt, Berkeley; Lamberth, Wade C.; Marcus, Melvin L.; Kerber, Richard E.

doi:10.1016/s0003-4975(10)64633-4

Cited by 31 publications

(33 citation statements)

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“…Anastomosis visualization and assessment in open-chest cases is reported to take approximately 1 min by Hiratzka et al [2] and Suematsu et al [17], and a median of 150s (range 54-335s) by Budde et al [29]. In another early study by Hiratzka et al [4], generally less than 5 min was required per anastomosis. Robot-assisted endoscopic coronary artery localization required less than 1 min and anastomosis assessment approximately 2 min in a closedchest, endoscopic off-pump pig model [26].…”

Section: Time Consumptionmentioning

confidence: 98%

“…Transducer size gradually decreased from rod-shaped transducers as large as 24 9 2.5 cm that were used in the pioneering 1980s studies [2][3][4] to (mini-) transducers as small as 1.5 9 0.9 9 0.6 cm [10,12,13,[15][16][17][20][21][22][23][24][25][26][27][28][29][30] (Fig. 1A).…”

Section: Transducer Sizementioning

confidence: 99%

“…Without stabilization, imaging of the beating heart is more difficult and prone to motion artefacts [1,14,26]. In CABG on the arrested heart, scanning may be performed during cardioplegia perfusion [3,14,29]. Color Doppler imaging, however, is less informative in this setting.…”

Section: Optimal Conditions For Scanningmentioning

confidence: 99%

“…Target coronary artery localization and/or assessment required less than one to several minutes [3,17,20,29,30]. Anastomosis visualization and assessment in open-chest cases is reported to take approximately 1 min by Hiratzka et al [2] and Suematsu et al [17], and a median of 150s (range 54-335s) by Budde et al [29].…”

Section: Time Consumptionmentioning

confidence: 99%

“…Its use was first reported in the 1980s [1][2][3][4][5][6]. At that time, however, bulky transducers limited their use to the anterior side of the heart, which prevented widespread adoption and application [1][2][3][4][5][6].…”

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confidence: 99%

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High-frequency epicardial ultrasound: review of a multipurpose intraoperative tool for coronary surgery

et al. 2008

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Background In open-chest coronary artery bypass grafting (CABG), the surgeon faces several intraoperative challenges: (1) to locate the target coronary artery, (2) to select the optimal anastomotic site, and (3) to assess the quality of the graft and distal anastomosis. Endoscopically, these three diagnostic aims are particularly challenging. Methods We reviewed the literature on the intraoperative application of high-frequency (6.5-15 MHz) epicardial ultrasound (ECUS) in CABG to aid in these challenges. Results Overall, ECUS was used in 628 patients to visualize and assess 912 (segments of) coronary arteries, as well as 418 grafts and distal anastomoses. In 96 cases, ECUS successfully located a coronary artery that was buried in the epicardial and/or myocardial tissue. In 37/155 (24%) imaged anastomotic sites, an alternative site free of pathology was selected. For quality assessment of the coronary anastomosis, experimental validation of ECUS included 218 anastomoses in ex vivo and animal models. ECUS showed high sensitivity (0.98) and specificity (1.00) for detection of anastomotic construction errors in 120 ex vivo anastomoses. In 418 grafts and distal anastomoses evaluated in patients, irregularities leading to revision were detected in 8 (1.9%) anastomoses and minor irregularities in an additional 23 (5.5%) anastomoses. However, little is known about the effect on long-term patency of specific anastomotic abnormalities revealed by ECUS. Scanning of arteries and anastomoses required several minutes. Current size ultrasound probes allowed successful experimental robot-assisted endoscopic application of ECUS. Conclusions CABG may be facilitated and improved in several ways by intraoperative high-frequency epicardial ultrasound scanning. Totally endoscopic CABG may benefit from ultrasound diagnostics in particular.

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Section: Time Consumptionmentioning

confidence: 98%

Section: Transducer Sizementioning

confidence: 99%

Section: Optimal Conditions For Scanningmentioning

confidence: 99%

Section: Time Consumptionmentioning

confidence: 99%

mentioning

confidence: 99%

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High-frequency epicardial ultrasound: review of a multipurpose intraoperative tool for coronary surgery

et al. 2008

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Systolic Total Narrowing of Left Anterior Descending Coronary Artery and Flow Interruption Secondary to Myocardial Bridge: A Rare Case Report and Review of Literature

Kacmaz

Alyan

İlkay

2008

Clinical Cardiology

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A 33-y-old man was admitted to the emergency department with sudden onset of severe substernal chest pain radiating to the left arm and neck. No pathological signs were recorded upon physical examination. The admission electrocardiogram (ECG) recorded during chest pain showed a large anterior wall myocardial infarction. Intravenous (IV) infusion of 1.5 million units of streptokinase over 1 h was initiated. Coronary angiography revealed total narrowing and flow interruption in the midsegment of the left anterior descending (LAD) coronary artery secondary to a myocardial bridge during systole and disappearance with diastole. He was discharged on aspirin (300 mg/d), metoprolol (100 mg/d), enalapril (10 mg twice daily), and atorvastatin (40 mg/d) treatment at the follow-up period.

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Coronary Artery Anomalies

Mazur

Siegel²,

Miszalski−Jamka

et al. 2013

CT Atlas of Adult Congenital Heart Disease

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Intraoperative High-Frequency Epicardial Echocardiography in Coronary Revascularization: Locating Deeply Embedded Coronary Arteries

Cited by 31 publications

References 2 publications

High-frequency epicardial ultrasound: review of a multipurpose intraoperative tool for coronary surgery

High-frequency epicardial ultrasound: review of a multipurpose intraoperative tool for coronary surgery

Systolic Total Narrowing of Left Anterior Descending Coronary Artery and Flow Interruption Secondary to Myocardial Bridge: A Rare Case Report and Review of Literature

Coronary Artery Anomalies

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