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Ann Thorac Surg 2009;88:632-636. doi:10.1016/j.athoracsur.2009.03.010
© 2009 The Society of Thoracic Surgeons
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Kirk Kanter
Paul Kirshbom
Kevin Maher
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New Technology

The Role of Intraoperative Indocyanine Green Fluorescence Angiography in Pediatric Cardiac Surgery

Brian Kogon, MDa,*, Janet Fernandez, BSb, Kirk Kanter, MDa, Paul Kirshbom, MDa, Bob Vincent, MDb, Kevin Maher, MDb, Nina Guzetta, MDc

a Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
b Sibley Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia
c Division of Anesthesia, Emory University School of Medicine, Atlanta, Georgia

Accepted for publication March 6, 2009.

* Address correspondence to Dr Kogon, Emory University, Children's Healthcare of Atlanta, Egleston, Atlanta, GA 30322 (Email: brian_kogon{at}emoryhealthcare.org).

Presented at the Poster Session of the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Purpose: In surgical reconstructions for congenital heart defects, vessel and anastomotic site patency is critical to success. Indocyanine green fluorescence angiography offers potential for a reliable and rapid method of intraoperative assessment. We sought to determine its feasibility in congenital heart surgery.

Description: Patients undergoing the following repairs were eligible for imaging: (1) coronary artery reimplantation, (2) coarctation, (3) palliative shunts, and (4) pulmonary artery reconstruction.

Evaluation: Adequate postoperative images were obtained in 18 of 30 (60%) patients. Image adequacy was highest for Blalock-Taussig shunts (100%), coarctation repairs (86%), coronary reimplantations (66%), lowest for the hemi-Fontan (0%), Fontan (40%), and pulmonary artery reconstructions (33%). All adequate images showed vessel or anastomotic site patency, which corresponded to the subsequent postoperative echocardiograms and cineangiograms. There were no adverse events or mortalities.

Conclusions: Indocyanine green fluorescence imaging may provide an additional intraoperative imaging modality. Ultimately, the surgical procedure may be assessed and revised, if necessary, prior to leaving the operating room. This potentially will reduce the need for subsequent postoperative interventions, along with their associated morbidity and mortality.






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