Abstract

A 59-year-old male with a history of unstable angina was diagnosed with a myocardial bridge of the left anterior descending artery (LAD) and apical variant hypertrophic cardiomyopathy (AHCM). He underwent unroofing of the myocardial bridge and a left ventricular apical myectomy. Intraoperatively, epicardial ultrasound was used to identify the myocardial bridge with systolic compression of the LAD and confirm the resolution of this compression postoperatively. (Figure 1) Furthermore, epicardial ultrasound was used for guiding the degree of apical resection of the decompressed heart. (Figure 2) This novel use of intraoperative epicardial ultrasound can help guide surgeons preoperatively and confirm results immediately after an operation. 

Summary

Similar to the real time feedback cardiologists get when performing coronary or valvular procedures on the beating heart, epicardial ultrasound gives the surgeon useful real-time guidance intraoperatively that may provide a safer, more effective result.

How the Medistim MiraQ was used

The surgical team used HFUS to examine the LAD trajectory and left ventricle apical myocardial thickness. The L15 Ultrasound Imaging probe helped identify the LAD under a layer of epicardial adipose tissue and traced the LAD more proximally to locate the myocardial bridge. The LAD was almost fully blocked during systole but open during diastole (Video 1). At the end of the procedure Imaging of the LAD was repeated and showed a patent vessel in both systole and diastole. (Video 2) 

The L15 Ultrasound Imaging probe was also used to help guide the resection of the hypertrophic apex. After coring out the apical septum and walls the HFUS was used to confirm good residual left ventricle wall thickness. (Video 3)

Reference

Lindsey Whalen, Stephen Davies, Karen Singh, et al. Epicardial Ultrasound in a Case of Myocardial Bridge and Apical Hypertrophic Cardiomyopathy. Authorea. April 17, 2020. 

https://journal.sketchingscience.org/users/312425/articles/443029-epicardial-ultrasound-in-a-case-of-myocardial-bridge-and-apical-hypertrophic-cardiomyopathy 

Case Attachments

Figure 1

Figure 2

Video 1

Video 2

Video 3