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Ann Thorac Surg 1994;57:1597-1604
© 1994 The Society of Thoracic Surgeons

Articles

Feasibility of intraoperative coronary angiography during hypothermie cardioplegic arrest

James A. Goldstein, MD*, Steven B. Laster, MD, T.Bruce Ferguson, Jr, MD

Division of Cardiology, Department of Mediane, and the Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA

Accepted for publication October 21, 1993.

* Address reprint requests to Dr Goldstein, Cardiovascular Division, Department of Internal Mediane, Washington University School of Medicine, 660 South Euclid Ave, Box 8086, St. Louis, MO 63110.

Although intraoperative coronary angioplasty has the potential to enhance revascularization in selected patients undergoing coronary bypass, this technique is only rarely performed, due in part to the lack of angiographic monitoring. Accordingly, to develop angiographic techniques potentially applicable to intraoperative angtoplasty, 6 conditioned dogs were placed on full catdiopulmonary bypass, the aorta was cross-clamped, and the heart arrested with cold catdioplegia solution. After 45 minutes of arrest, selective coronary angiography was performed employing catheters introduced through a proximal aortotomy. Small-volume contrast injections resulted in excellent opacificarion; however, the contrast agent stagnated within the coronary tree. Fortunately, intracoronary flush injection of the saline-cardioplegia solution resulted in immediate and complete contrast washout. After discontinuation of bypass, echocardiography revealed normal left and right ventricular function. Histopathologic analysis of tissue specimens from animals in which contrast was flushed documented the presence of normal coronary arteries and myocardium. These findings demonstrate methods by which intraoperative coronary angiography can be performed in the arrested heart without having adverse effects on either the cardiac function or histologic appearance. These techniques may have application for the performance of intraoperative angioplasty.




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