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.
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.