Eric N. Feins MD , Ming-Sing Si MD , Christopher W. Baird MD , Sitaram M. Emani MD
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引用次数: 4
Abstract
A clear understanding of coronary anatomy is critical in congenital heart surgery, especially when a ventriculotomy is planned, as in right ventricular outflow tract reconstructions and biventricular repairs. Typically, major epicardial coronary arteries are easily identified during first-time operations. However, in reoperative surgery, epicardial adhesions can obscure coronary vessels making their identification challenging. This paper describes the application of intraoperative fluorescence imaging in congenital heart surgery to obtain real-time coronary artery visualization for operative planning in order to avoid coronary injury. The fluorescence imaging utilizes indocyanine green (ICG). ICG is diluted to 0.28 mg/mL, and 0.1–1.0 mL of ICG solution is delivered via the cardioplegia cannula into the coronaries. A handheld imaging probe illuminates the field with near-infrared laser light, which excites ICG fluorescence. The fluorescence is captured by a camera, and the signal is transmitted to a monitor for real-time viewing. The imaging probe shows the precise coronary anatomy, enabling identification of the optimal ventriculotomy site. Intraoperative fluorescence imaging is a safe and effective technique for characterizing coronary anatomy. This technique enhances procedural planning and helps minimize the risk of coronary injury during reoperative congenital heart surgery.
在先天性心脏手术中,对冠状动脉解剖的清晰理解是至关重要的,特别是当计划进行心室切开术时,如右室流出道重建和双心室修复。通常,主要的心外膜冠状动脉在第一次手术中很容易被识别。然而,在再手术中,心外膜粘连会使冠状血管模糊,使其识别变得困难。本文介绍了术中荧光成像在先天性心脏手术中的应用,获得实时的冠状动脉图像,为手术规划提供依据,避免冠状动脉损伤。荧光成像利用吲哚菁绿(ICG)。将ICG稀释至0.28 mg/mL, 0.1-1.0 mL ICG溶液经停搏导管送入冠状动脉。手持成像探头用近红外激光照亮现场,激发ICG荧光。荧光被摄像机捕获,信号被传送到监视器进行实时观察。成像探头显示精确的冠状动脉解剖结构,从而确定最佳脑室切开术部位。术中荧光成像是一种安全有效的冠状动脉解剖表征技术。这项技术提高了手术计划,并有助于减少再手术先天性心脏手术时冠状动脉损伤的风险。
期刊介绍:
The Pediatric Cardiac Surgery Annual is a companion to Seminars in Thoracic and Cardiovascular Surgery . Together with the Seminars, the Annual provides complete coverage of the specialty by focusing on important developments in pediatric cardiac surgery. Each annual volume has an expert guest editor who invites prominent surgeons to review the areas of greatest change in pediatric cardiac surgery during the year. Topics include 1) Complete Atrioventricular Canal; 2) New Concepts of Cardiac Anatomy and Function -- The Helical Heart; 3) Valve Reconstruction (Replacement) in Congenital Heart Disease; 4) Evolving Developments in Congenital Heart Surgery.