Detection of Internal Thoracic Artery Dissection at Coronary Anastomosis Using Intraoperative 15-MHz High-Frequency Epicardial Ultrasound

This case report is based on the observations of a 66 year old man with 3 vessel disease who underwent off-pump coronary artery bypass grafting including a LIMA-LAD procedure. Routinely use of TTFM showed flow 10 ml/min, pulsatility index of 2, diastolic filling of 65% and an acceptable flow curve. The flow measurement was lower than expected and epicardial imaging was done by using a 15-Mhz high frequency ultrasound probe. This revealed an intimal flap of LIMA at the site of the anastomosis. The flow pattern was visualized by using Doppler color flow mapping.  The anastomosis was successfully revised and TTFM confirmed an adequate flow of 36 ml/min.