HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Cornelius Borst Paul F. Gründeman Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Borst, C. Articles by Gründeman, P. F. Search for Related Content PubMed Articles by Borst, C. Articles by Gründeman, P. F. Related Collections Coronary disease Related Article

J Thorac Cardiovasc Surg 2003;126:304-305
© 2003 The American Association for Thoracic Surgery

Letter to the editor

Reply to the editor

^a Department of Cardiology^a, University Medical Center Utrecht, Utrecht, The Netherlands
^b Department of Cardiothoracic Surgery^b, St Antonius Hospital, Nieuwegein, The Netherlands

We appreciate the letter by Suematsu and Takamoto in response to our work¹ and share their view² that the introduction of beating-heart coronary surgery³ warrants a renewed look at the potential diagnostic merits and limitations of epicardial ultrasonography with a high-frequency minitransducer.^1,2,4 They are correct in delineating the frequency band of the Aloka minitransducer in greater detail in its B-mode and its color Doppler mode.

One important feature of this transducer is its small size (16 x 6 x 9 mm). It fits in between the suction pods of the Octopus stabilizer in both longitudinal and transverse directions.^1,4 The versatile transducer easily reaches the posterior and inferior coronary arteries (unpublished observations in a pig model), in contrast to previously available transducers.

In the animal laboratory, we have been working with an experimental, identically sized, higher frequency Aloka probe (up to 13 MHz in B-mode) with higher echocardiographic element packing density. Both improvements provide a better image resolution than the probe used in the previous studies.^1,4 The 13-MHz miniprobe can be expected to answer in the operating room several pertinent questions before and after bypass surgery: location, depth, size, and grafting quality of the target coronary segment; absence of side branches in the segment to be isolated during grafting on the beating heart, to avoid profuse back bleeding that obscures the arteriotomy; geometry and quality of the anastomosis (absence of technical errors); quality of the distal runoff segment; and graft and coronary flows. It remains to be established which ultrasonographic modes yield the most useful information in the shortest scan time. Currently we favor the use of all three commonly available modes: conventional B-mode, directional color Doppler mode, and power Doppler mode. In color Doppler mode, the vessels are easily located, but artifacts caused by residual cardiac motion limit its accuracy in vessel dimension measurements.

Finally, we are reluctant as yet to share Suematsu and Takamoto’s enthusiasm for power Doppler–based 3-dimensional image reconstruction.⁵ In these images, diameter measurements are sensitive to turbulence and depend on the power gain setting. Thus diameters may be easily underestimated or overestimated. In the hands of Suematsu and colleagues,² however, anastomosis diameter measurements from 2-dimensional power Doppler and from angiographic images correlated remarkably well (r² = 0.944). The proposed method⁵ is illustrated by 3-dimensional images from the proximal anastomosis. Suematsu and colleagues⁵ did emphasize that the distal anastomosis cannot be visualized because of cardiac motion. Further judgment awaits a better time resolution.

	References

Top References

 

1. Eikelaar JH, Meijer R, Van Boven WJ, Klein P, Gründeman PF, Borst C. Epicardial 10-MHz ultrasound in off-pump coronary bypass surgery: a clinical feasibility study using a minitransducer. J Thorac Cardiovasc Surg. 2002;124:785–789
   
2. Suematsu Y, Takamoto S, Ohtsuka T. Intraoperative echocardiographic imaging of coronary arteries and graft anastomoses during coronary artery bypass grafting without cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2001;122:1147–1154
   
3. Van Dijk D, Jansen EW, Hijman R, Nierich AP, Diephuis JC, Moons KG, et al. Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial. JAMA. 2002;287:1405–1412
   
4. Klein P, Meijer R, Eikelaar JH, Gründeman PF, Borst C. Epicardial ultrasound in off-pump coronary artery bypass grafting: potential aid in intraoperative coronary diagnostics. Ann Thorac Surg. 2002;73:809–812
   
5. Suematsu Y, Takamoto S, Ohtsuka T. Real-time three-dimensional echocardiography evaluation of graft anastomoses during coronary artery bypass grafting: preliminary experience. Interactive Cardiovasc Thorac Surg. 2002;1:52–54
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Cornelius Borst Paul F. Gründeman Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Borst, C. Articles by Gründeman, P. F. Search for Related Content PubMed Articles by Borst, C. Articles by Gründeman, P. F. Related Collections Coronary disease Related Article