Case Report:
The use of intraoperative epicardial ultrasound to scan coronary
arteries in order to assess bypass graft targets and survey efficacy of
surgical re-vascularization is well described within the literature.(1)
Whereas the international Registry for Quality Assessment with
Ultrasound Imaging and TTFM in Cardiac Bypass Surgery (REQUEST) trial
utilized a 15 Mhz probe for scanning, recent literature describes the
use of an ultra-high frequency ultrasound (UHFUS) 70 Mhz probe for
anatomical assessment during non-cardiac surgery.(1, 2) We present a
case of intraoperative UHFUS use for epicoronary scanning in a patient
undergoing coronary artery bypass grafting (CABG) surgery. The patient
gave written permission to publish this case.
A 64 year old male with a past medical history significant for
hypertension and hyperlipidemia was referred to our service for
evaluation of his coronary artery disease. He reported worsening chest
pain with activity over the year prior to referral, and was evaluated
pre-operatively with both non-invasive and invasive cardiac testing.
Transthoracic echocardiography showed concentric left ventricular
hypertrophy with intact biventricular function. Left heart
catheterization showed extensive coronary disease including 95% left
main coronary occlusion, multiple discrete left anterior descending
(LAD) coronary occlusions ranging from 50%-100%, and a 90% right
coronary artery (RCA) lesion. The patient was scheduled for an on-pump
CABG surgery.
The patient was brought to the operating room where he was placed under
general anesthesia. After median sternotomy was performed, harvesting of
saphenous vein and bilateral mammary arteries commenced without event.
Both antegrade and retrograde cardioplegia were used to ensure
electromechanical silence of the heart during cardiopulmonary bypass. A
70 Mhz UFHUS probe was employed to assess the surface anatomy of the
native, diseased coronary arteries in order to optimize anatomical
planning for graft targets. After being placed in a sterile sleeve, the
probe was used to assess the LAD and posterior descending artery (PDA).
As noted in figure 1 and video 1, both cardioplegia flow and significant
calcifications were seen in the PDA. Figure 2 shows the LAD in short
axis, and calcifications are noted for both their bright echogenicity
and ultrasonic dropout artifact. Coronary grafting commenced and a
Doppler flowmeter was used to confirm patency. The patient had a
successful separation from cardiopulmonary bypass, uneventful
post-operative course, and was discharged on post-operative day seven.