Improving the Quality of Coronary Bypass Surgery With Intraoperative Angiography
Validation of a New Technique
Nimesh D. Desai, MD*,
Senri Miwa, MD, PhD,
David Kodama, BS,
Gideon Cohen, MD, PhD,
George T. Christakis, MD,
Bernard S. Goldman, MD,
Mark O. Baerlocher, MD,
Marc P. Pelletier, MD and
Stephen E. Fremes, MD
Sunnybrook and Women’s College Health Sciences Centre, University of Toronto, Toronto, Canada
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Figure 1 Indocyanine green angiograms of an in-situ left internal mammary artery (white arrow) bypass to left anterior descending coronary artery (black arrow). The distal anastomosis is well seen and denoted by the asterisk.
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Figure 2 Indocyanine green angiogram of a saphenous vein graft. (A) There is contrast dye in the vein graft (white arrow), but no dye enters the distal posterior descending coronary artery (black arrow). The distal anastomosis was reopened, and an occlusive stitch was found penetrating through the posterior wall of the target coronary vessel preventing antegrade flow. The anastomosis was revised. In the post-revision angiogram (B), contrast was observed to rapidly fill the vein graft (white arrow) and distal coronary vessel (black arrow).
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Figure 3 Comparison angiographic images of a kinked proximal vein bypass graft-aorta anastomosis seen on intraoperative indocyanine green angiogram (A, white arrow). The graft was repositioned without revision of the anastomosis. A post-operative conventional X-ray angiogram shows a similar lesion despite repositioning (B, black arrow).
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