Visualization of intramuscular left anterior descending coronary arteries during off-pump bypass surgery

The Prevalence and Anatomical Patterns of Intramuscular Coronary Arteries

“…A deep intramuscular artery may be difficult to localize, therefore the use of intraoperative echocardiographic Doppler has been proposed to visualize the artery (9,29,30). An intracavitary course of the LAD has been the cause of complications during coronary surgery, including perforation of the right ventricular wall during attempts of isolation of the intramuscular artery (11,(31)(32)(33).…”

“…Reduced coronary flow reserve and altered vasoreactivity has been documented in arteries with an intramuscular segment (3)(4)(5)8). In addition, myocardial bridging may present a technical challenge during coronary arterial bypass because surgical exposure of the intramuscular coronary artery may be difficult and may require the use of intraoperative echocardiography (9,10). Accidental opening of the right ventricle during dissection of intramuscular LAD is an undesired complication (11,12).…”

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

“…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).…”

“…Ninety-six cases of successful coronary artery localization with ECUS when conventional localization failed have been described [3,9,15,24,29,32]. Localization by ECUS took only a few minutes and allowed targeted dissection of the epicardial fat, minimizing risk and time consumption [3,17].…”

“…a Presented as number of site changes per total number of sites assessed for this purpose; b Mentioned that deeply located arteries could be found (no numbers given); c Number of successfully imaged arteries; an additional 19 could not be visualized due to the rigid probe handle. All patients were operated through a sternotomy approach, except the five patients from [15] Site selection with ECUS With ECUS, the quality of the target coronary artery can be rapidly and accurately assessed [1,3,5,9,11,12,15,17,20,22,24,29,30,32]. Measurement of the coronary lumen (as well as the internal mammary artery for size matching) by ECUS correlates well with both histological and angiographic dimensions [1,5,11,17,19,20].…”