The Annals of Thoracic Surgery, Vol 57, 1597-1604, Copyright © 1994 by The Society of Thoracic Surgeons
Feasibility of intraoperative coronary angiography during hypothermic cardioplegic arrest
JA Goldstein, SB Laster and TB Ferguson Jr
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 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 angioplasty, 6 conditioned dogs were placed on
full cardiopulmonary bypass, the aorta was cross-clamped, and the heart
arrested with cold cardioplegia 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 opacification; 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.
