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This case illustrates how High-frequency Ultrasound Imaging (HFUS) can be used during surgery to identify plaque in the aorta, avoid complications, and improve graft patency.
Undetected plaque in aorta led to surgical change
Intraoperative completion control with HFUS
In this case from the REQUEST study, a potential problem caused by manipulation of a calcified aorta was avoided. The plan was to perform the procedure on-pump, LIMA-LAD, SVG-OM, SVG-RCA. However, intraoperative imaging of the aorta prior to manipulation revealed previously undetected plaque in the ascending aorta as shown in Image 1. The surgeon modified the procedure to off-pump with a Y-graft for the targets on the left side of the heart (LIMA-LAD / LIMA-Y-RIMA-OM) and a composite graft for the RCA (RIMA in situ-SVG-RCA), see Image 2.
Case attachments
Click images below to view.
HFUS showing plaque in the aorta
Modified surgical procedure
Reference
Registry for Quality Assessment with Ultrasound Imaging and Transit-time FlowMeasurement in Cardiac Bypass Surgery
Taggart DP et al. Intraoperativetransit-time flow measurement and high-frequency ultrasound assessment incoronary artery bypass grafting. J Thorac Cardiovasc Surg. 2019; 159:1283-1292.
DOI: https://doi.org/10.1016/j.jtcvs.2019.05.087
Technology used
Medistim MiraQ™ Cardiac System with L15 High-Frequency Ultrasound Probe.
