Setty Sudarshan, Bello Ricardo, Leff Jonathan D
1Montefiore Medical Center, Bronx, NY, USA.
Semin Cardiothorac Vasc Anesth. 2014 Mar;18(1):71-3. doi: 10.1177/1089253213516804. Epub 2013 Dec 16.
The identification of coronary anatomy at the time of cardiac revascularization can be problematic. Preoperative studies (ie, coronary angiography) can aid in the mapping of the coronary anatomy. However, there remain a select few patients with intramyocardial coronaries that provide challenges for surgical dissection during revascularization. Probing the visible portion of the coronary artery, intraoperative cine angiography, thermal angiography, and epicardial Doppler probes have been used to identify the coronary anatomy intraoperatively. Aggressive surgical maneuvers can result in damage and increased time on cardiopulmonary bypass. Previous studies have used epicardial echocardiography on patients undergoing off-pump coronary artery bypass grafting. We report 2 cases in patients undergoing cardiac revascularization on cardiopulmonary bypass where the use of a high-frequency epicardial ultrasound probe facilitated the identification of the embedded coronary arteries. We describe a technique of using antegrade and retrograde cardioplegia administration sequentially to locate the coronary arteries. Easy availability and familiar technology make the epicardial Doppler probe an attractive tool for the identification of embedded coronary arteries.
在心脏血运重建时识别冠状动脉解剖结构可能存在问题。术前研究（即冠状动脉造影）有助于绘制冠状动脉解剖图。然而，仍有少数患者存在心肌内冠状动脉，这给血运重建期间的手术解剖带来挑战。探查冠状动脉的可见部分、术中电影血管造影、热血管造影和心外膜多普勒探头已被用于术中识别冠状动脉解剖结构。激进的手术操作可能导致损伤并延长体外循环时间。先前的研究已在接受非体外循环冠状动脉搭桥术的患者中使用心外膜超声心动图。我们报告了2例在体外循环下进行心脏血运重建的患者，其中使用高频心外膜超声探头有助于识别埋藏的冠状动脉。我们描述了一种依次使用顺行和逆行心脏停搏液给药来定位冠状动脉的技术。易于获得且技术熟悉使心外膜多普勒探头成为识别埋藏冠状动脉的有吸引力的工具。
