Off-pump coronary artery bypass grafting with device closure of atrial septal defect

Case report: Intraoperative reversal of flow through an atrial septal defect presenting as hypoxemia during off-pump coronary artery bypass grafting

The co-existence of atrial septal defect and coronary artery disease in a patient is rare in clinical practice. In the combined surgery of off-pump coronary artery bypass grafting and atrial septal defect closure, the unusual cardiac positions may affect the direction of blood shunting between the atriums, leading to more complex hemodynamic changes. Here, we report a case of a 67-year-old female who underwent refractory hypoxemia related to heart position in such a combined operation.

Optimal surface property for three-dimensional echo visualization

PURPOSE

Three-dimensional (3D) echo is a useful modality to guide off-pump intracardiac surgery, and this study aimed to determine the optimal surface property for minimizing echo dropout and grating lobes.

METHODS

A total of 13 specimens were examined. The specimens were scanned while they were rotated from 0° to 90°, and en face views were recorded in the 3D zoom mode. Changes in brightness were compared with the surface profile, which was traced from microscopic images. The brightness and size of grating lobes were also examined.

RESULTS

Decreases in brightness that were observed at a large rotation angle were classified into three groups (sharp, moderate, and gradual), and variation in the effective reflective plane size appeared to be a major determinant of this property. The same material showed different degrees of reflection depending on the surface profile. The size of grating lobes was affected by variation in the reflective plane size, but not by the intensity of reflection. The brightness of the grating lobes was similar among specimens.

CONCLUSIONS

These results suggest that echo dropout and grating lobes can be effectively eliminated by an appropriate surface profile; thus, a likely practical solution would be to manufacture a surface that provides an adequate reflective surface size at various incident angles.