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OBJECTIVE: High frequency epicardial ultrasound (ECUS) is a useful device to provide information about coronary artery, bypass graft function, and anastomosis configuration during coronary artery bypass grafting (CABG). Moreover, high frequency ECUS may also have potential for improved imaging in other area of cardiac surgery. In this study, we report the clinical applications of ECUS and the novel strategy using it in various cardiac procedures.
METHODS: We introduced an approach using high frequency ECUS into the various cardiac procedures. We directly scanned the cardiac lesions and obtained the optimum images. On the basis of these images, we made the surgical decisions conclusively.
RESULTS: High frequency ECUS could provide detailed images leading to successful surgical decision making. In the case with coronary artery fistula with coronary aneurysm, tortuous dilated left circumflex coronary artery (LCx) directly drained into the left ventricle (LV). It was difficult to determine the exact portion of the LCx drainage site into the LV by either palpation or direct vision. ECUS could detect the exact portion to ligate the drainage vessel. In the case with acute type A aortic dissection, emergent aortic arch replacement was performed without preoperative coronary angiography. Preoperative computed tomography showed left anterior descending artery (LAD) and right coronary artery (RCA) were calcified. ECUS could detect LAD stenosis, and thus we performed CABG to LAD. However, there was no stenosis in RCA so that CABG to RCA was not performed. In the case with ostial stenosis of RCA, the patient was scheduled to undergo aortic valve replacement (AVR). Preoperative angiography showed ostial stenosis of RCA was suspected, but uncertain. Intraoperative evaluation using ECUS revealed the mobile calcified plaque and restrictive color Doppler flow in right coronary ostium. Prior to AVR, CABG to RCA was performed for cardioplegia infusion. At the time of AVR, the calcified plaque in right coronary ostium was actually confirmed.
CONCLUSIONS: High frequency ECUS could provide accurate images and detailed information in various situations of cardiac surgery. It could assist successful surgical decision making and improve the safety and quality of cardiac surgery.