BACKGROUND: Homogenous distribution of cardioplegia delivered to the myocardium has been identified as an important predictor of post-cardiopulmonary bypass ventricular recovery and function. Presently, a method to determine adequate distribution of cardioplegia in patients during cardiac surgery does not exist. The goal of this study was to evaluate the feasibility of quantifying cardioplegia delivery using a novel, noninvasive optical method. Such a system would permit instantaneous imaging of jeopardized myocardium and allow immediate, intraoperative corrective measures. METHODS: We have previously developed a portable, intraoperative near-infrared (NIR) fluorescence imaging system for use in large animal cardiac surgery that simultaneously displays color video and NIR fluorescent images of the surgical field. By introducing exogenous, NIR fluorophores, specific cardiac functions can be visualized in real-time. RESULTS: In a porcine cardiopulmonary bypass model, we demonstrate that the FDA-approved intravascular fluorophore indocyanine green (ICG) permits real-time assessment of cardioplegia delivery. ICG was injected into an aortic root and/or transatrial coronary sinus catheter during delivery of crystalloid cardioplegia solution. Segmental distribution was immediately noted at the time of injection. In a subset of animals, simulated coronary occlusions resulted in imaging defects consistent with poor cardioplegia delivery and jeopardized myocardium. Videodensitometric analysis was performed on-line to quantify distribution to the right ventricle and left ventricle. CONCLUSION: We report the development of a novel, noninvasive, intraoperative technique that can easily and safely provide a visual assessment of cardioplegia delivery (antegrade and/or retrograde) and that offers the potential to quantify the relative segmental distribution during cardiac surgical procedures.
BACKGROUND: Homogenous distribution of cardioplegia delivered to the myocardium has been identified as an important predictor of post-cardiopulmonary bypass ventricular recovery and function. Presently, a method to determine adequate distribution of cardioplegia in patients during cardiac surgery does not exist. The goal of this study was to evaluate the feasibility of quantifying cardioplegia delivery using a novel, noninvasive optical method. Such a system would permit instantaneous imaging of jeopardized myocardium and allow immediate, intraoperative corrective measures. METHODS: We have previously developed a portable, intraoperative near-infrared (NIR) fluorescence imaging system for use in large animal cardiac surgery that simultaneously displays color video and NIR fluorescent images of the surgical field. By introducing exogenous, NIR fluorophores, specific cardiac functions can be visualized in real-time. RESULTS: In a porcine cardiopulmonary bypass model, we demonstrate that the FDA-approved intravascular fluorophore indocyanine green (ICG) permits real-time assessment of cardioplegia delivery. ICG was injected into an aortic root and/or transatrial coronary sinus catheter during delivery of crystalloid cardioplegia solution. Segmental distribution was immediately noted at the time of injection. In a subset of animals, simulated coronary occlusions resulted in imaging defects consistent with poor cardioplegia delivery and jeopardized myocardium. Videodensitometric analysis was performed on-line to quantify distribution to the right ventricle and left ventricle. CONCLUSION: We report the development of a novel, noninvasive, intraoperative technique that can easily and safely provide a visual assessment of cardioplegia delivery (antegrade and/or retrograde) and that offers the potential to quantify the relative segmental distribution during cardiac surgical procedures.
Authors: Sungjee Kim; Yong Taik Lim; Edward G Soltesz; Alec M De Grand; Jaihyoung Lee; Akira Nakayama; J Anthony Parker; Tomislav Mihaljevic; Rita G Laurence; Delphine M Dor; Lawrence H Cohn; Moungi G Bawendi; John V Frangioni Journal: Nat Biotechnol Date: 2003-12-07 Impact factor: 54.908
Authors: P X Adams; J N Cunningham; N K Trehan; J R Brazier; G E Reed; F C Spencer Journal: J Thorac Cardiovasc Surg Date: 1978-04 Impact factor: 5.209
Authors: S F Khuri; M Josa; W Marston; N S Braunwald; B Smith; D Tow; M VanCisin; E M Barsamian Journal: J Thorac Cardiovasc Surg Date: 1983-11 Impact factor: 5.209
Authors: Sylvain Gioux; Vida Kianzad; Razvan Ciocan; Hak Soo Choi; Chad Nelson; Jeffrey Thumm; Robert J Filkins; Stephen J Lomnes; John V Frangioni Journal: Proc SPIE Int Soc Opt Eng Date: 2008
Authors: Eiichi Tanaka; Frederick Y Chen; Robert Flaumenhaft; Gwenda J Graham; Rita G Laurence; John V Frangioni Journal: J Thorac Cardiovasc Surg Date: 2009-07 Impact factor: 5.209
Authors: Susan L Troyan; Vida Kianzad; Summer L Gibbs-Strauss; Sylvain Gioux; Aya Matsui; Rafiou Oketokoun; Long Ngo; Ali Khamene; Fred Azar; John V Frangioni Journal: Ann Surg Oncol Date: 2009-07-07 Impact factor: 5.344