Validierung der Fluoreszenzangiographie für die intraoperative Beurteilung und Quantifizierung der Myokardperfusion
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vor 18 Jahren
BACKGROUND: Intraoperative graft patency verification is of major
clinical importance for quality control after coronary artery
bypass grafting (CABG), especially if surgery is performed on the
beating heart. This is one of the first reports of fluorescence
coronary angiography (FCA) using the dye indocyanine green (ICG), a
noninvasive technology for direct visualization of coronary
arteries and myocardial perfusion. METHODS: Twenty-five domestic
pigs underwent FCA of the left anterior descending coronary artery
(LAD). In the first group (n = 6 pigs), FCA was used to visualize
the native coronary vessels and myocardial perfusion. In the second
group (n = 8 pigs), 14 stenoses of various degrees and 4 total
vessel occlusions were created by snares on different segments of
the LAD, and FCA was used to visualize the effects of these
obstructions. In the third group (n = 11 pigs) defined stenoses
(25%; 50%, 75%, 100% flow reduction) on the distal part of the LAD
were created by a custom-made screw occluder and determined using
TTFM (transit-time-flow measurement). ICG was intravenously
applied, and the heart was illuminated with near-infrared light
emitted by laser diodes. The fluorescence emission was detected by
an adapted charge-coupled device camera system. The images were
displayed in real time on a high-resolution monitor. Subsequently,
images obtained with FCA were correlated with fluorescent
microspheres data (n = 11 pigs). RESULTS: In all cases,
high-quality FCA images of coronary arteries and myocardial
perfusion were obtained. All stenoses resulted in an impairment of
the myocardial perfusion visualized by FCA. Occlusion of the LAD or
the diagonal branch resulted in a total perfusion defect of the
corresponding anterior myocardial wall with immediate reperfusion
after releasing the snare. Correlation between FCA and fluorescent
microspheres in determination of myocardial perfusion was
excellent. CONCLUSION: With the fluorescence technique using ICG,
visualization of blood flow in coronary vessels and myocardial
perfusion, is feasible. FCA is a highly sensitive and reproducible
method and an excellent technique for intraoperative quality
control in CABG.
clinical importance for quality control after coronary artery
bypass grafting (CABG), especially if surgery is performed on the
beating heart. This is one of the first reports of fluorescence
coronary angiography (FCA) using the dye indocyanine green (ICG), a
noninvasive technology for direct visualization of coronary
arteries and myocardial perfusion. METHODS: Twenty-five domestic
pigs underwent FCA of the left anterior descending coronary artery
(LAD). In the first group (n = 6 pigs), FCA was used to visualize
the native coronary vessels and myocardial perfusion. In the second
group (n = 8 pigs), 14 stenoses of various degrees and 4 total
vessel occlusions were created by snares on different segments of
the LAD, and FCA was used to visualize the effects of these
obstructions. In the third group (n = 11 pigs) defined stenoses
(25%; 50%, 75%, 100% flow reduction) on the distal part of the LAD
were created by a custom-made screw occluder and determined using
TTFM (transit-time-flow measurement). ICG was intravenously
applied, and the heart was illuminated with near-infrared light
emitted by laser diodes. The fluorescence emission was detected by
an adapted charge-coupled device camera system. The images were
displayed in real time on a high-resolution monitor. Subsequently,
images obtained with FCA were correlated with fluorescent
microspheres data (n = 11 pigs). RESULTS: In all cases,
high-quality FCA images of coronary arteries and myocardial
perfusion were obtained. All stenoses resulted in an impairment of
the myocardial perfusion visualized by FCA. Occlusion of the LAD or
the diagonal branch resulted in a total perfusion defect of the
corresponding anterior myocardial wall with immediate reperfusion
after releasing the snare. Correlation between FCA and fluorescent
microspheres in determination of myocardial perfusion was
excellent. CONCLUSION: With the fluorescence technique using ICG,
visualization of blood flow in coronary vessels and myocardial
perfusion, is feasible. FCA is a highly sensitive and reproducible
method and an excellent technique for intraoperative quality
control in CABG.
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