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Intraoperative echocardiographic coronary artery imaging in congenital and acquired heart disease

  • Deane Yim (a1), Luc Mertens (a2), Osami Honjo (a3) and Lynne E. Nield (a2)

Abstract

Transoesophageal and epicardial echocardiography are indispensible intraoperative imaging modalities to guide paediatric heart disease surgeries and influence surgical decision-making. A less well-described role of intraoperative imaging is its utility in evaluating coronary artery patency and flow. Focused two-dimensional, colour, and spectral Doppler imaging of the coronary arteries should be performed during surgeries involving coronary manipulation or re-implantation, or in cases where there is unexpected ventricular dysfunction or electrographic signs concerning for ischaemia. Intraoperative imaging allows for any anatomical issues to be detected and addressed promptly in the operating room. Imaging of the coronary arteries should identify unobstructed coronary ostia and proximal course without kinking, angulation, narrowing, or significant calibre change to suggest stenosis or extrinsic compression from neighbouring structures. The aim of this review is to highlight the usefulness of transoesophageal and epicardial echocardiography in evaluating coronary artery patency and flow, provide a how-to guide for optimal imaging, and to introduce a practical guideline to achieve best clinical practice.

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Corresponding author

Author for correspondence: Dr Deane Yim, Division of Paediatric Cardiology, Perth Children’s Hospital, 15 Hospital Avenue, Nedlands, Perth, WA 6009, Australia. Tel: +61-8-6456 2222. E-mail: Deane.Yim@health.wa.gov.au

References

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1.Zwicky, P, Daniel, WG, Mugge, A, Lichtlen, PR.Imaging of Coronary Arteries by Color-Coded Transesophageal Doppler Echocardiography. Am J Cardiol 1988; 62: 639640.
2.Ayres, NA, Miller-Hance, W, Fyfe, DA, et al.Indications and Guidelines for Performance of Transesophageal Echocardiography in the Patient with Pediatric Acquired or Congenital Heart Disease: Report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr 2005; 18: 9198.
3.Eltzschig, HK, Rosenberger, P, Loffler, M, et al.Impact of Intraoperative Transesophageal Echocardiography on Surgical Decisions in 12,566 Patients Undergoing Cardiac Surgery. Ann Thorac Surg 2008; 85: 845852.
4.Gurbuz, AT, Hecht, ML, Arslan, AH.Intraoperative Transesophageal Echocardiography Modifies Strategy in Off-Pump Coronary Artery Bypass Grafting. Ann Thorac Surg 2007; 83: 10351040.
5.Dragulescu, A, Golding, F, Van Arsdell, G, et al.The Impact of Additional Epicardial Imaging to Transesophageal Echocardiography on Intraoperative Detection of Residual Lesions in Congenital Heart Surgery. J Thorac Cardiovasc Surg 2012; 143: 361367.
6.Fraser, CD, Liu, RH, Zhou, X, et al.Valve-Sparing Aortic Root Replacement in Children: Outcomes from 100 Consecutive Cases. J Thorac Cardiovasc Surg 2019; 157: 11001109.
7.Ochi, M.Review: Surgical Treatment of Giant Coronary Aneurysms in Pediatric Patients with Kawasaki Disease. Gen Thorac Cardiovasc Surg 2018; 66: 121129.
8.Scohy, TV, Gommers, D, Jan ten Harkel, AD, et al.Intraoperative Evaluation of Micromultiplane Transesophageal Echocardiographic Probe in Surgery for Congenital Heart Disease. Eur J Echocardiogr 2007; 8: 241246.
9.Pavithran, S, Natarajan, K, Vishwambaran, B, Arke, AD, Sivakumar, K.Preliminary Evaluation of a Microtransesophageal Probe in Neonates and Young Infants Undergoing Surgery for Congenital Heart Disease. Ann Pediatr Cardiol 2014; 7: 173179.
10.Lang, RM, Badano, LP, Tsang, W, et al.Eae/Ase Recommendations for Image Acquisition and Display Using Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2012; 25: 346.
11.Wong, D, Golding, F, Hess, L, et al.Intraoperative Coronary Artery Pulse Doppler Patterns in Patients with Complete Transposition of the Great Arteries Undergoing the Arterial Switch Operation. Am Heart J 2008; 156: 466472.
12.Yamagishi, M, Yasu, T, Ohara, K, Kuro, M, Miyatake, K.Detection of Coronary Blood Flow Associated with Left Main Coronary Artery Stenosis by Transesophageal Doppler Color Flow Echocardiography. J Am Coll Cardiol 1991; 17: 8793.
13.Arnaiz, E, Koolbergen, D, Adsuar, A, Hazekamp, MG.Surgery for Supravalvular Aortic Stenosis – the Three-Patch Technique. Multimed Man Cardiothorac Surg 2008; 2008: mmcts 2006 002329.
14.Koh, TW, Ferdinand, FD, Jin, XY, Gibson, DG, Pepper, JR.Coronary Artery Problems During Homograft Aortic Valve Replacement: Role of Transesophageal Echocardiography. Ann Thorac Surg 1997; 64: 533535.
15.Delgado, V, Ng, AC, Shanks, M, et al.Transcatheter Aortic Valve Implantation: Role of Multimodality Cardiac Imaging. Expert Rev Cardiovasc Ther 2010; 8: 113123.
16.Savage, RM, Lytle, BW, Aronson, S, et al.Intraoperative Echocardiography Is Indicated in High-Risk Coronary Artery Bypass Grafting. Ann Thorac Surg 1997; 64: 368373; discussion 73–4.
17.Guarracino, F, Cariello, C, Tritapepe, L, et al.Transoesophageal Echocardiography During Coronary Artery Bypass Procedures: Impact on Surgical Planning. HSR Proc Intensive Care Cardiovasc Anesth 2010; 2: 4349.
18.Sung, SC, Chang, YH, Lee, HD, et al.Arterial Switch Operation for Transposition of the Great Arteries with Coronary Arteries from a Single Aortic Sinus. Ann Thorac Surg 2005; 80: 636641.
19.Kirklin, JW, Blackstone, EH, Tchervenkov, CI, Castaneda, AR.Clinical Outcomes after the Arterial Switch Operation for Transposition. Patient, Support, Procedural, and Institutional Risk Factors. Congenital Heart Surgeons Society. Circulation 1992; 86: 15011515.
20.Khairy, P, Clair, M, Fernandes, SM, et al.Cardiovascular Outcomes after the Arterial Switch Operation for D-Transposition of the Great Arteries. Circulation 2013; 127: 331339.
21.Tardif, JC, Vannan, MA, Taylor, K, Schwartz, SL, Pandian, NG.Delineation of Extended Lengths of Coronary Arteries by Multiplane Transesophageal Echocardiography. J Am Coll Cardiol 1994; 24: 909919.
22.Xing, YQ, Khabbaz, KR, Karia, D, et al.Intraoperative Epicardial Coronary Artery Imaging: Rationale, Methods, and Applications. Echocardiography 2002; 19: 735741.
23.Arruda, AM, Dearani, JA, Click, RL, Ishikura, F, Seward, JB.Intraoperative Application of Power Doppler Imaging: Visualization of Myocardial Perfusion after Anastomosis of Left Internal Thoracic Artery to Left Anterior Descending Coronary Artery. J Am Soc Echocardiogr 1999; 12: 650654.
24.Fernandes, F, Alam, M, Smith, S, Khaja, F.The Role of Transesophageal Echocardiography in Identifying Anomalous Coronary Arteries. Circulation 1993; 88: 25322540.
25.Kasprzak, JD, Kratochwil, D, Peruga, JZ, et al.Coronary Anomalies Diagnosed with Transesophageal Echocardiography: Complementary Clinical Value in Adults. Int J Card Imaging 1998; 14: 8995.
26.Chigurupati, K, Sukesan, S, Lovhale, PS, Dharan, BS, Koshy, T.Comprehensive Intraoperative Transesophageal Echocardiography of Anomalous Left Coronary Artery from Pulmonary Artery: What to Look for and Where to Look? Echocardiography 2018; 35: 391395.

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Intraoperative echocardiographic coronary artery imaging in congenital and acquired heart disease

  • Deane Yim (a1), Luc Mertens (a2), Osami Honjo (a3) and Lynne E. Nield (a2)

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