Intraoperative echocardiographic coronary artery imaging in congenital and acquired heart disease

Abstract

<jats:title>Abstract</jats:title><jats:p>Transoesophageal and epicardial echocardiography are indispensible intraoperative imaging modalities to guide paediatric heart disease surgeries and influence surgical decision-making. A less well-described role of intraoperative imaging is its utility in evaluating coronary artery patency and flow. Focused two-dimensional, colour, and spectral Doppler imaging of the coronary arteries should be performed during surgeries involving coronary manipulation or re-implantation, or in cases where there is unexpected ventricular dysfunction or electrographic signs concerning for ischaemia. Intraoperative imaging allows for any anatomical issues to be detected and addressed promptly in the operating room. Imaging of the coronary arteries should identify unobstructed coronary ostia and proximal course without kinking, angulation, narrowing, or significant calibre change to suggest stenosis or extrinsic compression from neighbouring structures. The aim of this review is to highlight the usefulness of transoesophageal and epicardial echocardiography in evaluating coronary artery patency and flow, provide a how-to guide for optimal imaging, and to introduce a practical guideline to achieve best clinical practice.</jats:p>

Role of Transesophageal Echocardiography in the Diagnosis of Coronary Ischemia in a Patient with History of Ross Procedure

“… 14 Yim et al. 15 elaborated on this further, describing techniques and proposing a guideline on how to visualize the coronary artery and flow in patients with congenital and acquired heart disease.…”

Prospective Assessment of Coronary Artery Flows Before and After Cardiopulmonary Bypass in Children With a Spectrum of Congenital Heart Disease

“…"Normal" baseline flow velocities in the left coronary artery are generally accepted between 30 and 60 cm/s depending on the age of the patient, either invasively, or by echocardiography. [6][7][8][9][10] Studies have shown that coronary artery velocities in children decrease with age and heart rate 11 and that coronary flow velocities in infants and children are higher than those in adults. 12 Interestingly, in neonates, coronary velocities show a linear increase with age and left ventricular (LV) mass.…”

“…Coronary artery imaging was obtained from the short axis for the right coronary artery (RCA), left main coronary artery, LAD, and circumflex arteries as per our previously published protocols. 8 For all coronaries, a 2D image of the vessel was obtained, and for the RCA and left main coronary artery, the connection to the aortic sinus was obtained. Colour and pulse wave Dopplers were obtained for each coronary artery when possible, with at least 3 consecutive heart beats and optimal image quality.…”