INTRAOPERATIVE CORONARY ANGIOGRAPHY USING FLUORESCEIN - BASIC STUDIES AND CLINICAL-APPLICATION

To improve the safety and reliability of coronary artery bypass grafting (CABG), intraoperative coronary angiography using fluorescein was investigated both experimentally and clinically. Results. In experiments using mongrel dogs, the optimal procedures were determined to be as follows. 1. Complete all distal anastomoses. 2. Under the illumination of a 6-watt black light hung 10 cm above the heart, 0.06% fluorescein (0.5 mg/kg BW) is injected as a bolus from the proximal end of the graft. Histologically the direct injection of fluorescein into the coronary artery was shown to cause no injury to the vascular wall. In clinical application, the distribution of the graft flow, the area perfused through the graft, and the patency of the anastomoses were well evaluated in real time by observing the fluorescence. Unexpected narrowing of the anastomosis and the maldistribution of graft flow were detected in 2 patients by this examination during cardioplegic arrest, and the necessity for additional grafting, as well as the extent of revascularization, could be evaluated on the operating table. It was concluded that intraoperative coronary angiography using fluorescein rapidly provided essential information for the real-time evaluation of CABG surgery without any side effects.