Soltesz Edward G, Laurence Rita G, De Grand Alec M, Cohn Lawrence H, Mihaljevic Tomislav, Frangioni John V
Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Heart Surg Forum. 2007;10(5):E381-6. doi: 10.1532/HSF98.20071099.
Homogenous distribution of cardioplegia delivered to the myocardium has been identified as an important predictor of post-cardiopulmonary bypass ventricular recovery and function. Presently, a method to determine adequate distribution of cardioplegia in patients during cardiac surgery does not exist. The goal of this study was to evaluate the feasibility of quantifying cardioplegia delivery using a novel, noninvasive optical method. Such a system would permit instantaneous imaging of jeopardized myocardium and allow immediate, intraoperative corrective measures.
We have previously developed a portable, intraoperative near-infrared (NIR) fluorescence imaging system for use in large animal cardiac surgery that simultaneously displays color video and NIR fluorescent images of the surgical field. By introducing exogenous, NIR fluorophores, specific cardiac functions can be visualized in real-time.
In a porcine cardiopulmonary bypass model, we demonstrate that the FDA-approved intravascular fluorophore indocyanine green (ICG) permits real-time assessment of cardioplegia delivery. ICG was injected into an aortic root and/or transatrial coronary sinus catheter during delivery of crystalloid cardioplegia solution. Segmental distribution was immediately noted at the time of injection. In a subset of animals, simulated coronary occlusions resulted in imaging defects consistent with poor cardioplegia delivery and jeopardized myocardium. Videodensitometric analysis was performed on-line to quantify distribution to the right ventricle and left ventricle.
We report the development of a novel, noninvasive, intraoperative technique that can easily and safely provide a visual assessment of cardioplegia delivery (antegrade and/or retrograde) and that offers the potential to quantify the relative segmental distribution during cardiac surgical procedures.
已确定输送至心肌的心脏停搏液均匀分布是体外循环后心室恢复和功能的重要预测指标。目前，尚无一种方法可在心脏手术期间确定患者心脏停搏液的充分分布情况。本研究的目的是评估使用一种新型非侵入性光学方法量化心脏停搏液输送的可行性。这样的系统将能够对濒危心肌进行即时成像，并允许立即采取术中纠正措施。
我们先前已开发出一种便携式术中近红外（NIR）荧光成像系统，用于大型动物心脏手术，该系统可同时显示手术视野的彩色视频和NIR荧光图像。通过引入外源性NIR荧光团，可实时可视化特定的心脏功能。
在猪体外循环模型中，我们证明美国食品药品监督管理局（FDA）批准的血管内荧光团吲哚菁绿（ICG）可实时评估心脏停搏液的输送情况。在输注晶体心脏停搏液期间，将ICG注入主动脉根部和/或经心房冠状窦导管。注射时立即注意到节段性分布。在一部分动物中，模拟冠状动脉闭塞导致成像缺陷，与心脏停搏液输送不良和心肌濒危一致。对右心室和左心室的分布进行在线视频密度分析以进行量化。
我们报告了一种新型非侵入性术中技术的开发，该技术可轻松、安全地对心脏停搏液输送（顺行和/或逆行）进行视觉评估，并有可能在心脏手术过程中量化相对节段性分布。
