• Luiz F Maracaja Neto, Raj Modak, and Robert B Schonberger.
• From the *Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas; and †Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut.
• Anesth. Analg. 2017 Apr 1; 124 (4): 1087-1090.

AbstractCoronary blood flow can be disrupted during cardiac interventions such as mitral valve surgeries, left atrial appendage ligation, transcatheter aortic valve implantation, and aortic procedures involving reimplantation of coronary buttons. Although difficult to accomplish, coronary imaging using transesophageal echocardiography can be performed by the use of orthogonal imaging with the ability for real-time tilt for angle adjustment. The technique described herein allows imaging of the right coronary artery, left main coronary artery bifurcation, left anterior descending, and circumflex coronary arteries. The imaging is facilitated by acquisition during the delivery of blood cardioplegia. Coronary sinus and great cardiac vein imaging also can be obtained during the delivery of retrograde cardioplegia. Although further studies are needed, this imaging technique may prove useful in procedures where coronary flow disruption is suspected or as an additional parameter to confirm delivery of cardioplegia.

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