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Intraoperative echocardiographic coronary artery imaging in congenital and acquired heart disease

Published online by Cambridge University Press:  05 February 2020

Deane Yim
Affiliation:
Division of Paediatric Cardiology, Perth Children’s Hospital, Perth, Australia
Luc Mertens
Affiliation:
Division of Paediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada
Osami Honjo
Affiliation:
Department of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
Lynne E. Nield
Affiliation:
Division of Paediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada
Corresponding

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.

Type
Review Article
Copyright
© The Author(s) 2020. Published by Cambridge University Press

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