Intraoperative Transesophageal Echocardiography for Coronary Artery Assessment

Figures

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  Figure 1.. Transesophageal echocardiograms and epicardial ultrasonography of intraoperative dissection in the left main truncus (LMT). (A) Intact LMT before cardiopulmonary bypass (CPB). (B) An unusual lumen was observed, but LMT flow became undetectable. A-AO, ascending aorta. (C) A flap occluded the left anterior descending artery (LAD). LCX, left circumflex artery.

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  Figure 2.. Schematic diagrams showing the criteria for transesophageal echocardiography (TEE) findings and measurements. (A) Short-axis view of aortic valve (AV). Anomalous origin was identified and the length of the left main truncus (LMT) and the diameter of the left and right coronary arteries (LCA and RCA, respectively) were measured. LAD, left anterior descending artery; LCX, left circumflex artery. (B) Long-axis view of the AV. Low and high takeoff was examined with reference to the aortic annulus and sinotubular junction (STJ). A-AO, ascending aorta.

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  Figure 3.. Anomalous origin of the right and left coronary arteries (RCA and LCA, respectively). (A–D) Anomalous origin of the LCA in Patient 35. The orifice is adjacent to the commissure between the non-coronary and left coronary cusps (NCC and LCC, respectively). RCC, right coronary cusp. (E–G) Anomalous origin of the RCA at the commissure between the RCC and LCC in Patient 124.

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  Figure 4.. High takeoff of the right coronary artery (RCA). (A) The origin is just below the sinotubular junction (STJ). (B) Marked calcification of the ascending aorta (A-AO) above the STJ. (C) Epicardial ultrasonogram of RCA without detectable blood flow.

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  Figure 5.. Measurement of the diameter of the right and left coronary arteries (RCA and LCA, respectively). (A) Correlation between the diameter measured on coronary angiograms (CAG) and on transesophageal echocardiograms (TEE). (B) An average size LCA ostium. LMT, left main truncus. (C) The largest LCA ostium in the present series. (D) Acoustic shadows adjacent to the LMT were considered to be an additional coronary artery in Patient 116. A-SH, acoustic shadow; LAD, left anterior descending artery; LCX, left circumflex artery.

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  Figure 6.. Assessment of a short left main truncus (LMT). (A) Misdiagnosed short LMT in Patient 29. A-SH, acoustic shadow; LCX, left circumflex artery. (B) An accelerated flow signal was seen in the left anterior descending artery (LAD). (C) Coronary angiogram showing that the LMT is not short. (D) A short LMT visualized in the short-axis view of the aortic valve in Patient 130. (E) Malperfusion during selective cardioplegia. A flow signal was not detected in the LAD. (F) After the cannula was replaced, flow was detected in both arteries.

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  Figure 7.. Calcified protrusion (CALC) adjacent to the left coronary artery ostium in Patient 59. (A,B) Strongly echogenic protrusion adjacent to left main truncus (LMT) associated with acoustic shadow (A-SH) in 2-dimensional images. (C,D) Protrusion and ostium shown in a 3D image.

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  Figure 8.. Calcified plaque (CALC) in the left main truncus (LMT) in Patient 64. (A) Aortic valve short-axis view. (B) Aortic valve long-axis view.