[Coronary artery imagings by intraoperative two-dimensional echocardiography].

Using a new diagnostic ultrasonographic apparatus for tomographic imagings during surgery, we attempted to image the coronary arteries to delineate vascular lesions. Twenty patients were studied, including four with ischemic heart disease, eight with valvular disease, and eight with congenital anomalies. A T-shaped, 7.5 MHz electronically-focused linear array scanner sterilized with formalin gas was placed directly over the exposed surface of the heart. Echocardiograms of the coronary systems were obtained in the following selected planes. Plane 1: With the scanner probe on the main pulmonary artery, the main trunk of the left coronary artery (LMT) was imaged; Planes 2 and 3: Tomographic imaging of the left anterior descending artery (LAD) was accomplished with the probe of the scanner applied to the anterior interventricular sulcus; Planes 4 and 5: For imaging the right coronary artery (RCA), the scanner probe was placed over the right atrioventricular groove. The LMT and its branches (LAD and the circumflex branch, Cx) were readily visualized echocardiographically in plane 1 in nearly all cases examined. Satisfactory imagings of the RCA were also easily achieved in planes 4 and 5. Nevertheless, attempts to image the LAD in planes 2 and 3 entailed some difficulty. Echograms of adult patients were of higher intensity and brighter, with an increased prominence of the intima of the coronary arteries, compared to those of children. The echocardiographic features in coronary artery stenosis were remarkably consistent with the angiographic findings in respect to the location of stenotic lesions. Advantages of echographic observations of the coronary arteries using this noninvasive procedure lie not only in providing accurate information as to the site of stenosis but in delineating the morphologic features of the vessel wall, as well. Using this procedure optimal sites for vascular graft sutures in cases requiring aorto-coronary bypass surgery may be appropriately selected, hence this is a valuable diagnostic aid to increase the safety of surgical procedures.