Intraoperative perfusion contrast echocardiography. Initial experience during coronary artery bypass grafting

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 99; no. 3; pp. 536 - 542
• Main Authors: Kabas, JS, Kisslo, J, Flick, CL, Johnson, SH, Craig, DM, Stanley, TE, Smith, PK
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA AATS/WTSA 01.03.1990; Elsevier
• Subjects: Aged; Aorta - physiology; Biological and medical sciences; Contrast Media; Coronary Artery Bypass; Coronary Circulation; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Echocardiography - methods; Humans; Image Enhancement; Intraoperative Care; Male; Medical sciences; Middle Aged; Saphenous Vein - physiology; Saphenous Vein - transplantation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Time Factors; Human; Echocardiography; Aortocoronary; Bypass; Perfusion; Surgery; Ultrasonic investigation; Cardiovascular disease; Intraoperative; Contrast media
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/s0022-5223(19)36985-5

Intraoperative evaluation of the effectiveness of myocardial revascularization has been limited by an inability to assess regional myocardial perfusion. Microbubbles of sonicated diatrizoate sodium and diatrizoate meglumine (Renografin) have been an effective echocardiographic contrast agent and have been employed clinically during cardiac catheterization. This recent development in contrast-enhanced two-dimensional echocardiography permits real-time imaging of transmural myocardial blood flow but has not been evaluated in the operating room. This study represents the initial surgical application of this directed technique and was designed to evaluate the safety and efficacy of intraoperative perfusion contrast echocardiography in assessing the results of coronary artery bypass grafting. Twenty men with significant coronary artery disease ranging in age from 49 to 73 years were studied. Direct contrast agent injection into completed saphenous vein bypass grafts caused the myocardium supplied by each graft to be well delineated and provided a tomographic view of contrast distribution. The enhanced region was well correlated with the size and distribution of the native vessel. Rapid contrast washout (less than 20 seconds) indicated satisfactory regional perfusion. Contrast echocardiography prolonged the operation less than 10 minutes and did not result in any perioperative complications.