The Role of Intraoperative Indocyanine Green Fluorescence Angiography in Pediatric Cardiac Surgery

• Published in: The Annals of thoracic surgery Vol. 88; no. 2; pp. 632 - 636
• Main Authors: Kogon, Brian, MD, Fernandez, Janet, BS, Kanter, Kirk, MD, Kirshbom, Paul, MD, Vincent, Bob, MD, Maher, Kevin, MD, Guzetta, Nina, MD
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2009; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aortic Coarctation - surgery; Biological and medical sciences; Cardiac Surgical Procedures; Cardiology. Vascular system; Cardiothoracic Surgery; Cardiovascular system; Coloring Agents; Coronary Angiography; Coronary Vessels - surgery; Feasibility Studies; Fontan Procedure; Heart Defects, Congenital - surgery; Humans; Indocyanine Green; Intraoperative Period; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Pneumology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Surgery; Vascular Patency; 18; Human; Pediatrics; Radiodiagnosis; Angiography; Fluorescence; Anesthesia; Intraoperative; Indocyanine green; Circulatory system; Cardiac surgery; Cardiology; Child
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2009.03.010

Purpose In surgical reconstructions for congenital heart defects, vessel and anastomotic site patency is critical to success. Indocyanine green fluorescence angiography offers potential for a reliable and rapid method of intraoperative assessment. We sought to determine its feasibility in congenital heart surgery. Description Patients undergoing the following repairs were eligible for imaging: (1) coronary artery reimplantation, (2) coarctation, (3) palliative shunts, and (4) pulmonary artery reconstruction. Evaluation Adequate postoperative images were obtained in 18 of 30 (60%) patients. Image adequacy was highest for Blalock-Taussig shunts (100%), coarctation repairs (86%), coronary reimplantations (66%), lowest for the hemi-Fontan (0%), Fontan (40%), and pulmonary artery reconstructions (33%). All adequate images showed vessel or anastomotic site patency, which corresponded to the subsequent postoperative echocardiograms and cineangiograms. There were no adverse events or mortalities. Conclusions Indocyanine green fluorescence imaging may provide an additional intraoperative imaging modality. Ultimately, the surgical procedure may be assessed and revised, if necessary, prior to leaving the operating room. This potentially will reduce the need for subsequent postoperative interventions, along with their associated morbidity and mortality.