New Procedure to Detect Intra-Muscular and/or Intra-Fat Coronary Artery Using an Ultrasonic Flowmeter

(Department of Cardiovascular Surgery, St. Marianna University, School of Medicine, Kawasaki, Japan and Department of Cardiovascular Surgery*, Ishioka Noushinkeigeka Hospital, Ishioka, Japan)

Keita Kikuchi Haruo Makuuchi Hiroshi Murakami
Takamaro Suzuki Takashi Ando Makoto Ohno
Hirokuni Ono Kiyoshi Chiba Shinichi Endo*
Detection of the coronary artery is usually an easy procedure in the coronary artery surgery. However in cases with an intra-muscular and/or intra-fat coronary artery, it requires special skill and experience. Dissection of epicardial adipose tissue and/or muscle along the epicardial groove is a common procedure to reach such coronary artery in conventional CABG (C-CABG). Recently, off-pump CABG (OPCAB) has become a standard operation, and detection of such a coronary artery is difficult under the beating heart. Then conversion to the C-CABG becomes necessary to avoid ventricular rupture. We report a new procedure to easily detect such a coronary artery in OPCAB, using an ultrasonic flowmeter used in neurosurgery. Because the tip of the probe is small (2mm in diameter) and flexible, its handling is quite similar to that of the micro-blade knife. Furthermore, audiable Doppler flow sound allows detection and dissection of the coronary artery without looking away from the operative field to check the coronary flow. In our case, use of the instrument enabled us to detect the anterior descending branch of the left coronary artery which was very deep in adipose tissue. Therefore, application of this ultrasound instrument is beneficial in OPCAB with an intra-muscular and/or intra-fat coronary artery.
@Jpn. J. Cardiovasc. Surg. 34: 159-161 (2005)