Visualization Of Coronary Arteries Research Articles

Accuracy and Potential Benefit of Ultraselective Invasive Coronary Angiography Guided by Computed Tomographic Coronary Angiography.

It is unknown whether computed tomographic coronary angiography (CTCA) can be used to perform ultraselective invasive coronary angiography (ICA) by only visualizing the abnormal coronary artery on CTCA and defer visualization of the normal contralateral coronary artery. This study assessed the accuracy of CTCA in patients with coronary artery disease (CAD) on CTCA limited to either the left (LCA) or right coronary artery (RCA) in predicting a contralateral coronary artery without abnormalities on CTCA determined to be normal by ICA. This retrospective analysis included patients with CAD limited to the LCA or RCA on CTCA. Primary endpoint was the accuracy of CTCA to predict a contralateral coronary artery without abnormalities on CTCA to be normal by ICA. Secondary endpoints were potential reductions in procedure time and radiation exposure if an ultraselective ICA approach would be used compared to standard ICA. In total, 202 patients were included. CTCA was correct in predicting a normal contralateral coronary artery in 201 of the 202 patients (99.5%). Deferring ICA of the normal contralateral coronary artery on CTCA resulted in a potential reduction in procedure time and dose area product of 4.22 ± 2.67 minutes (61 ± 16% reduction) and 1501 ± 1304 mGy•cm² (29 ± 13% reduction). In this retrospective study, CTCA was extremely accurate in predicting a normal contralateral coronary artery in patients with LCA- or RCA-limited CAD on CTCA. A potential CTCA-guided ultraselective ICA approach was feasible and would have led to a considerable decrease in procedure time and radiation exposure.

Prognostic value of Doppler coronary artery assessment in comparison with other echocardiographic prognostic parameters

Abstract Funding Acknowledgements Type of funding sources: None. Background Coronary artery Doppler assessment during routine echocardiography is an established diagnostic tool, that was proved by previous investigators. The prognostic value of impaired coronary flow in left coronary artery was also recently shown in pilot studies [1, 2]. A low feasibility and unknown prognostic value in comparison with other traditional echocardiographic parameters in non-selected population are considered as the main limitations of this method. Aim To evaluate feasibility and the prognostic value of coronary artery ultrasound assessment in a non-selected population in everyday clinical practice in comparison with other echocardiographic parameters. Methods: 581 non-selected patients were screened in prospective cohort study. Left coronary artery flow was scanned in addition to conventional echocardiography. Follow-up period was 12 months. All-cause mortality, myocardial infarction, revascularization, and hospitalization due to heart failure decompensation were defined as major adverse cardiac events (MACE). Results: Feasibility of coronary artery visualization and Doppler assessment was 89.8%. Follow-up was available in 92% of patients; during this period 22 deaths and 1 non-fatal MI occurred, 116 patients had MACE. In univariable analysis age, global longitudinal strain (GLS), left atrium index and maximal coronary velocity were predictors for all-cause death (p < 0.006-0.0001), but ejection fraction was not (p < 0.29). In multivariable analysis maximal coronary velocity (HR: 1.02, 95%, CI: 1.01-1.03, p < 0.0006), age (HR: 1.06, 95%, CI: 1.01-1.11, p < 0.02), and left atrium index (HR: 1.05, 95%, CI: 1.01-1.08, p < 0.007) were independent predictors for all-cause death. Maximal coronary velocity (HR: 1.02, 95%, CI: 1.01-1.03, p < 0.0001), age (HR: 1.03, 95%, CI: 1.01-1.05, p < 0.006), GLS (HR: 0.90, 95%, CI: 0.85-0.96, p < 0.0008) and left atrium index (HR: 1.02, 95%, CI: 1.01-1.04, p < 0.009) were independent predictors for MACE. Conclusion Doppler coronary flow velocity scanning during routine echocardiography is a feasible and valuable tool for assessment of short-term prognosis in non-selected patients. Its short-term prognostic value is better than prognostic value of ejection fraction and global longitudinal strain for the same patients. Abstract Figure. Coronary flow velocity

Coronary Artery Visualization by Using the 64-row MDCT in Pediatric Patients

We retrospectively evaluated the visualization of pediatric coronary computed tomography angiography (CCTA) images by using the 64-detector row CT scanner between the electrocardiogram-gated helical scan and non-electrocardiogram-gated helical scan. From January 2015 to March 2019, 100 children who underwent CT angiography examination were retrospectively enrolled. Group A consisted of 50 patients with electrocardiogram-gated helical scan. Group B consisted of 50 patients with non-electrocardiogram-gated helical scan. All patients were scanned using a 64-detector row CT scanner (LightSpeed VCT), and helical scans were acquired. The CT scanning parameters were 0.4-s rotation, 0.625-mm slice thickness, 0.24 (group A) helical pitch (beam pitch), 1.375 (group B) helical pitch (beam pitch), 80 kVp, and 50-300 mA (noise index 40). A retrospective method was used for electrocardiogram gated. To compare the radiation dose, CT volume dose index (CTDIvol) and dose length product (DLP) displayed on the console were recorded. The visualization scores of the coronary artery images were compared between each group. In group A, CTDIvol and DLP values were 6.74 (1.05-11.97) mGy and 79.87 (15.90-146.65) mGy·cm, respectively. In group B, CTDIvol and DLP values were 0.51 (0.39-0.95) mGy and 8.15 (6.30-17.50) mGy·cm, respectively. There were significant differences in CTDIvol and DLP values between both groups (p<0.05). The visualization rates for the proximal and distal coronary arteries were 88% and 54% for the right coronary artery, 84% and 58% for the left anterior descending artery, and 66% and 30% for the left circumflex branch in group A, respectively. The visualization rates for the proximal and distal coronary arteries were 52% and 0% for the right coronary artery, 56% and 0% for the left anterior descending artery, and 32% and 0% for the left circumflex branch in group B. In 64-row multidetector computed tomography (MDCT), the visualization rates for the proximal and distal coronary arteries were significantly higher in the electrocardiogram-gated scan, but the exposure dose was several times higher in the pediatric CCTA. For accurate diagnosis in pediatric coronary arteries, electrocardiogram-gated helical scan should be performed.

Evaluation of coronary arteries in congenital heart disease in children: diagnostic comparison of electrocardiogram-gated and non-electro-cardiogram-gated computed tomography cardiac angiography.

To compare the visualization and anatomy of coronary arteries in children (≤ 2 years) with congenital heart disease (CHD) on non-electrocardiogram (ECG)-gated and ECG-gated computed tomography angiography (CTA). In this retrospective study, approved by the Ethics Committee of our institute, evaluation of coronary arteries in CHD was performed in 40 children on non-ECG-gated CTA and in 42 children on ECG-gated CTA. The origin and course of the right coronary artery (RCA), left main coronary artery (LMCA), left anterior descending (LAD) artery, and left circumflex (LCX) artery were evaluated by 2 paediatric radiologists independently. ECG-gated CT scans yielded increased (additional) visualization of all the coronary arteries, when compared to non-ECG-gated CT scans. The RCA, LMCA, LAD artery, and LCX artery were visualized in 47.5%, 62.5%, 55%, and 32.5% of children, respectively, on non-ECG-gated studies, while they were visualized in 64.3%, 92.8%, 80.9%, and 62% children, respectively, on ECG-gated studies. The coronary artery anatomical variations were also supplementarily detected more in the ECG-gated group (23.8%) than in the non-ECG gated group (2.5%). ECG-gated CT cardiac angiography studies yield enhanced diagnostic outcomes for the evaluation of the coronary arteries in comparison to non-ECG-gated studies.

Evaluation of coronary flow with computed tomography derived FFR: Advantages and pitfalls

Coronary computed tomographic angiography (CCTA) is an excellent noninvasive, anatomic imaging modality for direct visualization of coronary arteries and for the assessment of coronary artery disease (CAD). CCTA has high sensitivity and high negative-predictive value for the identification of obstructive CAD; however, its specificity and positive-predictive value are low. After more than a decade of using CCTA to assess the anatomic severity of CAD, novel modalities of obtaining functional information from CCTA have been developed to increase its specificity and accuracy. These modalities use computational fluid dynamics to calculate fractional flow reserve (FFR) from CCTA datasets. Computed tomography-derived FFR (FFRCT) predicts virtual hyperemia for computation. Therefore, no additional image acquisition, medication, radiation exposure, or pharmacologic stress agent during CCTA examination are necessary for the calculation of FFRCT. Multiple, prospective single or multicenter studies have shown that FFRCT is poised to become a gate-keeper for catheterization laboratory. In this article, we aim to review the principles, diagnostic accuracy, advantages, limitations, and pitfalls of FFRCT.

Single-catheter dual-modality intravascular imaging combining IVUS and OFDI: a holistic structural visualisation of coronary arteries.

Single-catheter dual-modality intravascular imaging combining IVUS and OFDI: a holistic structural visualisation of coronary arteries.

3D-printed visualization of a double right coronary artery with intra-atrial course

3D-printed visualization of a double right coronary artery with intra-atrial course

Evaluation of image quality and radiation dose with prospective ECG-gated 80 multi-slice CT scan in 182 consecutive children examinations with congenital heart disease

Computed tomography angiography (CTA) is a reliable imaging tool to evaluate children congenital heart disease (CHD) but requires radiation exposure. This study aims to investigate image quality and radiation dose with a prospective electrocardiogram (ECG)-gated 80 multi-slice CTA, in 182 consecutive children examinations with CHD. In total, 182 consecutive examinations performed with a prospective ECG-gated 80 multi-slice CTA from March 2016 to December 2017 in Nantes university hospital were retrospectively analyzed. Radiation dose was assessed by dose length product (DLP) and effective dose (E). Objective quality image was assessed by contrast to noise ratio (CNR). Subjective quality image was assessed by two radiologists with a 10-point scale evaluating visualization of coronary arteries. Correlation between quality image, radiation dose, age, weight, heart rate was analyzed. DLP and E were 29.3 ± 15.5 mGy.cm and 0.6 ± 0.2 mSv, respectively. Agreement between radiologists in assessment of subjective image quality was 0.79. Subjective image quality score was significantly better ( P < 0.01) with higher age, weight, DLP and lower heart rate in univariate analysis. CNR was significantly lower with increasing weight and DLP ( P < 0.05) but there was no correlation between CNR and age and heart rate. Prospective ECG-gated 80 multi-slice CTA is performing for the evaluation of children CHD with good image quality and low radiation dose. Visualization of small structures is better when age and weight increase, heart rate decreases and when radiation dose is more important. CNR evolves in the opposite side to subjective image quality score. It seems less appropriate to assess image quality from clinical viewpoint of the radiologist.

Coronary Arteries: Normal Anatomy With Historical Notes and Embryology of Main Stems.

Anatomy of subepicardial coronary arteries became a topic of investigation at autopsy in Florence (Italy) by Banchi in the early twentieth century, with the discovery of dominant and balanced patterns. Thereafter, in the 60's of the same century Baroldi in Milan did post-mortem injection with spectacular three-dimensional casts. Later Sones at the Cleveland Clinic introduced selective coronary arteriography for in vivo visualization of coronary arteries. In the present chapter we show these patterns, as well as normal variants of origin and course with questionable risk of ischemia, like myocardial bridge as well as origin of the left circumflex coronary artery from the right sinus with retroaortic course. As far as embryology, the coronary arteries and veins are epicardial in origin and finally connect the former with the aorta, and the latter with the sinus venosus. At the time of spongy myocardium, intramural blood supply derives directly by the ventricular cavities, whereas later, at the time of myocardial compaction, vascularization originates from the subepicardial network. The connection of the subepicardial plexus with the aorta occurs with prongs of the peritruncal ring, which penetrate the facing aortic sinuses. Septation of truncus arteriosus is not responsible for the final position of the coronary orifices. Infact in transposition of the great arteries coronary ostia are regularly located within facing sinuses of the anterior aorta.

Optical Coherence Tomography of the Coronary Arteries.

Intravascular imaging, particularly optical coherence tomography, has brought significant improvement in diagnostic and therapeutical approaches to coronary artery disease and has offered superior high-resolution visualization of coronary arteries. The ability to obtain images of intramural and transmural coronary structures allows the study of the process of atherosclerosis, effect of therapies, mechanism of acute coronary syndrome and stent failure, and performance of new devices and enables the interventional cardiologist to optimize the effect of percutaneous coronary intervention. In this review, we provide the summary of the latest published data on clinical use of optical coherence tomography as well as practical algorithm for optical coherence tomography-guided percutaneous coronary intervention for daily interventional practice.

Variations in Sedated Echocardiography and Association With Repeat Echocardiography in Nonrefractory Kawasaki Disease.

Echocardiography performed under sedation allows for better coronary artery visualization in children with Kawasaki disease. We sought to describe hospital-level variability in the percentage of sedated echocardiography (SE) among children with nonrefractory Kawasaki disease (NRKD) and then test its association with repeat echocardiography, length of stay (LOS), and costs. We identified children in the Pediatric Health Information System <36 months of age hospitalized with NRKD from March 2010 to February 2017. Hospital-level percentage of SE was the primary outcome. Secondary outcomes were repeat echocardiography during the same hospitalization, LOS, and costs. We used χ2 and Wilcoxon rank tests to compare differences in repeat echocardiography between SE and nonsedated echocardiography. Pearson correlation was used to test associations between SE and repeat echocardiography, LOS, and costs. There were 2887 NRKD hospitalizations from 40 children's hospitals. Initial SE varied from 0.0% to 87.0% (median 5.9%; interquartile range 1.4%-21.1%). Of initial echocardiographies, 22.4% were sedated and 10.1% of all hospitalizations had a repeat echocardiography. Use of SE at the hospital level was associated with a lower likelihood for repeat echocardiography (r = -0.32; 95% confidence interval -0.58 to -0.01; P = .042). Absolute risk reduction was 3.5% and the number needed to sedate was 29. Initial SE was not associated with LOS or hospital-level costs but was associated with increased patient-level costs. Significant variation exists in the use of SE for children <36 months of age with NRKD at children's hospitals. Our results suggest that determination of SE should not be driven by concern for repeat echocardiography or LOS considerations.

Echocardiographic Visualization of Retroaortic Anomalous Coronary Artery

Echocardiographic Visualization of Retroaortic Anomalous Coronary Artery

Determination of optimal fluoroscopic angulations for aorto-coronary ostial interventions from coronary computed tomography angiography

BackgroundAn optimal aorto-coronary angiographic projection, characterized by an orthogonal visualization of the proximal coronary artery, is crucial for interventional success. We determined the distribution of optimal C-arm positions and assessed their feasibility by invasive coronary angiography. MethodsOrthogonal aorto-coronary ostial angulations were determined in 310 CT data sets. In 100 patients undergoing subsequent invasive angiography, we assessed if the CT-predicted angulations were achievable by the C-arm system. If the predicted projection was not achievable due to mechanical constraints of the C-arm system, the most close, achievable angulation was determined. Patient characteristics were analyzed regarding the distribution of optimal angulations and its feasibility by the C-arm system. ResultsFor the left ostium, CT revealed a mean angulation of LAO 23 ​± ​21°/cranial 25 ​± ​23° (90% of patients with a LAO/cranial angulation, 3% LAO/caudal, 4% RAO/cranial, 3% RAO/caudal) and were achievable by the C-arm system in 87% of patients. For the right ostium, the mean CT-predicted orthogonal angulation was LAO 36 ​± ​37°/cranial 36 ​± ​51° (84% LAO/cranial, 2% LAO/caudal, 14% RAO/caudal) and achievable by the C-arm system in 45% of patients. For the left ostium, a higher body weight was associated with a steeper LAO/cranial angulation being less feasible by the C-arm system due to mechanical constraints. ConclusionsOrthogonal aorto-left coronary angulations show a relative narrow distribution predominately in LAO/cranial position whereas a wider range of angulations was found for the right coronary ostium. The feasibility of CT-predicted angulations by the C-arm system is more restricted for the right than the left coronary ostium.

Possibilities of Stress Computed Tomography Myocardial Perfusion Imaging in the Diagnosis of Ischemic Heart Disease

Computed tomography angiography (CT-angiography, CTA) allows noninvasive visualization of coronary arteries (CA). This method is highly sensitive in detecting coronary atherosclerosis. However, standard CTA does not allow evaluation of the hemodynamic significance of found CA stenoses, which requires additional functional tests for detection of myocardial ischemia. This review focuses on possibilities of clinical use, limitations, technical aspects, and prospects of a combination of CT-angiography and CT myocardial perfusion imaging in diagnostics of ischemic heart disease.

Validation of a novel cardiac motion correction algorithm for x-ray computed tomography: From phantom experiments to initial clinical experience.

A novel cardiac motion correction algorithm has been introduced recently. Unlike other segmentation-based approaches it is fully automatic and capable of correcting motion artifacts of myocardial wall and other moving structures as well as coronary arteries of the heart. In addition, it requires raw data of only less than a single rotation for motion estimation and correction, which is a significant advantage from the perspective of x-ray exposure and workflow. The aim of this study is to explore the capability of the proposed method through phantoms and in-vivo experiments. Motion correction of coronary arteries and other heart structures including myocardial wall is the main focus of the evaluation. First, we provide a brief introduction to the concept of the motion correction algorithm. Next we address the procedure of our studies using an XCAT phantom and commercially available physical phantoms. Results of XCAT phantom demonstrate that our solution significantly improves the structural similarity of coronary arteries compared to FBP (proposed: 0.94, FBP: 0.77, p<0.001). Besides, it provides significantly lower root mean square error (proposed: 20.27, FBP: 25.33, p = 0.01) of the whole heart image. Mocomo phantom study shows that the proposed method improves the visualization of coronary arteries estimated based on motion score (1: worst, 5: best) from two experienced radiologists (proposed: 3.5, FBP: 2.1, p<0.001). The results of these phantom studies reveal that the proposed has a great potential in handling motion artifacts of other heart structures as well as coronary arteries. Finally, we provide the results of in-vivo animal and human studies. The 3D and 4D heart images show a consistently superior performance in the visualization of coronary arteries along with myocardial wall and other cardiothoracic structures. Based on these findings of our studies, we are of the opinion that our solution has a considerable potential to improve temporal resolution of cardiac CT imaging. This would open the door to innovations in structural or functional diagnosis of the heart.

Virtual endoluminal aortic root views determined at coronary CT angiography - an important tool for improving anomalous coronary artery visualization and surgical planning.

Anomalous origin of the coronary arteries, though uncommon, is of great clinical concern. It can be the cause of sudden cardiac death and abnormal cardiac hemodynamics. Advances in electrocardiographically (ECG)-gated multi-detector CT have increased diagnostic accuracy in detecting anomalous origin of coronary arteries and their interarterial and intramural courses. Recent advances in multi-detector CT image processing software have allowed the creation of virtual endoluminal views of the aortic root and improved assessment of the intramural course (the length and relationship to the intercoronary commissure) of the coronary artery, which is of considerable surgical importance. We review our experience with virtual endoluminal imaging in our first 19 cases of interarterial coronary artery anomalies (17 cases of interarterial with intramural segment and 2 cases of purely interarterial course) diagnosed preoperatively and proven surgically.

Visualization of proximal coronary arteries on high-pitch electrocardiogram-triggered computed tomography in pediatric congenital heart disease: effects of heart rate and body surface area.

As CT technology has advanced, techniques for pediatric cardiac CT in congenital heart disease have evolved from retrospective electrocardiography (ECG)-gating with relatively high radiation doses to lower-dose prospective ECG-gating and even single-beat gated scans. Despite these advances, coronary artery imaging in children remains challenging because of their small vessel size and high heart rates, often necessitating retrospective gating. Evaluate coronary artery visualization in pediatric patients (<20years) who underwent low-dose high-pitch ECG-triggered scans and stratify the probability of coronary artery visualization based upon heart rate and body surface area (BSA). Two hundred eleven high-pitch ECG-triggered studies from April 2014 to November 2017 were reviewed by two pediatric cardiac imagers in this retrospective study. Patient age, gender, BSA, average heart rate, heart rate variability and use of general anesthesia were recorded as well as dose-length product (DLP) and volumetric CT dose index (CTDIvol). We assessed the coronary artery score using a 5-point scale, with score of ≥3 considered of diagnostic quality. We performed multivariate statistical analysis including logistic regression to analyze effects of heart rate and BSA. Patient age range was 1day to 19years (median age 3years). Heart rate range was 49-188 beats per minute (bpm; median 122bpm) and BSA range was 0.15-2.07m2 (median 0.53m2). The origin and proximal coronary arteries were confidently seen (score ≥3) in 61% of studies in this cohort. Coronary artery visualization scores further increased with increased BSA (P<0.002) and with decreased heart rate (P<0.001). At heart rates <100bpm or in patients with BSA>0.58, adequate coronary artery visualization was present 72% of the time. While in many patients the coronary artery origins are visualized using high-pitch ECG-triggered technique, the importance of coronary artery visualization needs to be weighed with the radiation dose penalty in individual patients to achieve optimal imaging.

Region based coronary artery segmentation using modified Frangi's vesselness measure

AbstractRecent research suggests that the cardiovascular diseases (CVDs), seem to be the foremost cause of mortality among the world populace. Three dimensional (3D) imaging modality such as computed tomography angiography(CTA) is a standard noninvasive imaging modality which has great potentials for the visualization of heart and coronary arteries. This article presents a fully automated method for coronary artery extraction using modified Frangi's vesselness measure and region based segmentation. In this article, grayness and gradient based measures are used while computing Frangi's vesselness measure to improve the extraction of coronary arteries. The obtained vesselness measures are utilized for automatically computing the location of ostia. The locations of ostia are then used as starting seed points in region growing segmentation to extract coronary arteries. Three major coronary arteries, namely the left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA) are segmented using the proposed method and the centerlines are extracted for the main coronary branches. The performance of the proposed method is evaluated using 12 3D CCTA data set. The experimental results reveal that during the calculation of modified Frangi's vesselness measure the proposed method gives improved results. The qualitative results obtained during the segmentation stage are also convincing. The average segmentation accuracy and overlap measure of the proposed method are 97.4% and 77.86%, respectively. Hence, the proposed automated approach can detect and extract coronary arteries in CCTA images with high performance.

Accelerated high-resolution free-breathing 3D whole-heart T2-prepared black-blood and bright-blood cardiovascular magnetic resonance

BackgroundThe free-breathing 3D whole-heart T2-prepared Bright-blood and black-blOOd phase SensiTive inversion recovery (BOOST) cardiovascular magnetic resonance (CMR) sequence was recently proposed for simultaneous bright-blood coronary CMR angiography and black-blood late gadolinium enhancement (LGE) imaging. This sequence enables simultaneous visualization of cardiac anatomy, coronary arteries and fibrosis. However, high-resolution (< 1.4 × 1.4 × 1.4 mm3) fully-sampled BOOST requires long acquisition times of ~ 20 min.MethodsIn this work, we propose to extend a highly efficient respiratory-resolved motion-corrected reconstruction framework (XD-ORCCA) to T2-prepared BOOST to enable high-resolution 3D whole-heart coronary CMR angiography and black-blood LGE in a clinically feasible scan time. Twelve healthy subjects were imaged without contrast injection (pre-contrast BOOST) and 10 patients with suspected cardiovascular disease were imaged after contrast injection (post-contrast BOOST). A quantitative analysis software was used to compare accelerated pre-contrast BOOST against the fully-sampled counterpart (vessel sharpness and length of the left and right coronary arteries). Moreover, three cardiologists performed diagnostic image quality scoring for clinical 2D LGE and both bright- and black-blood 3D BOOST imaging using a 4-point scale (1–4, non-diagnostic–fully diagnostic). A two one-sided test of equivalence (TOST) was performed to compare the pre-contrast BOOST images. Nonparametric TOST was performed to compare post-contrast BOOST image quality scores.ResultsThe proposed method produces images from 3.8 × accelerated non-contrast-enhanced BOOST acquisitions with comparable vessel length and sharpness to those obtained from fully- sampled scans in healthy subjects. Moreover, in terms of visual grading, the 3D BOOST LGE datasets (median 4) and the clinical 2D counterpart (median 3.5) were found to be statistically equivalent (p < 0.05). In addition, bright-blood BOOST images allowed for visualization of the proximal and middle left anterior descending and right coronary sections with high diagnostic quality (mean score > 3.5).ConclusionsThe proposed framework provides high‐resolution 3D whole-heart BOOST images from a single free-breathing acquisition in ~ 7 min.

Intraoperative Coronary Artery Imaging for Planning.

A clear understanding of coronary anatomy is critical in congenital heart surgery, especially when a ventriculotomy is planned, as in right ventricular outflow tract reconstructions and biventricular repairs. Typically, major epicardial coronary arteries are easily identified during first-time operations. However, in reoperative surgery, epicardial adhesions can obscure coronary vessels making their identification challenging. This paper describes the application of intraoperative fluorescence imaging in congenital heart surgery to obtain real-time coronary artery visualization for operative planning in order to avoid coronary injury. The fluorescence imaging utilizes indocyanine green (ICG). ICG is diluted to 0.28 mg/mL, and 0.1-1.0 mL of ICG solution is delivered via the cardioplegia cannula into the coronaries. A handheld imaging probe illuminates the field with near-infrared laser light, which excites ICG fluorescence. The fluorescence is captured by a camera, and the signal is transmitted to a monitor for real-time viewing. The imaging probe shows the precise coronary anatomy, enabling identification of the optimal ventriculotomy site. Intraoperative fluorescence imaging is a safe and effective technique for characterizing coronary anatomy. This technique enhances procedural planning and helps minimize the risk of coronary injury during reoperative congenital heart surgery.