High-frequency ultrasound imaging of LAD embedded 6mm deep

Case

This case illustrates how High-frequency Ultrasound Imaging (HFUS) can be used during surgery to detect intramural vessels, to avoid complications, and improve graft patency.

Patient Information

In this case from the REQUEST Study, the target site was an intramural LAD. By using high-frequency ultrasound imaging the surgeon was able to detect the LAD at approximately 6 mm depth as shown in image 1. This image also shows that the LAD has a lumen with a diameter ≥ 1.5 mm in the scanned area. The vessel walls are nice and clean without plaque or calcifications, confirming that this site is well suited for the planned anastomosis.

Intraoperative

Image 1 shows the LAD embedded in the myocardium. The proximal wall is 6 mm down in the myocardium and would be difficult to find without the help of HFUS. The image also shows that the LAD has a lumen ≥ 1.5 mm in the scanned area. The vessel walls are nice and clean without plaque or calcifications, confirming that this site is well suited for the planned anastomosis.

The intraoperative picture as seen in image 2 shows the finished anastomosis and confirms that it is open. The graft was also assessed with TTFM and confirmed to have good flow and low PI.

Reference

Reference: Taggart et al. JTCVS 2020;159:1283-92.

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