Intraoperative Fluorescence with Indocyanine Green in Congenital Cardiac Surgery: Potential Applications of a Novel Technology

Abstract Background Achieving successful repairs for congenital heart defects requires attention to details. Careful evaluation of anastomotic site patency, reimplanted coronary arteries, location of epicardial coronaries, and myocardial perfusion may be required to ensure safe conduct for the operation and achieve excellent outcomes We used intraoperative fluorescence to answer some of these questions. Methods Intraoperative fluorescence angiography was performed using indocyanine green in patients undergoing the following procedures: (1) coronary artery reimplantation, (2) coronary artery unroofing, (3) evaluation of intraoperative coronary anatomy, (4) reoperations where ventriculotomy was required, (5) coarctation/interrupted aortic arch repair, (6) systemic-to-pulmonary artery shunts, (7) Norwood procedure, (8) thoracic duct localization, and (9) vascular rings. Results The technique was feasible in all patients. No mortalities or adverse events were encountered related to the dye. Adequate intraoperative imaging was obtained in fifteen patients (20 images) which correlated well with postoperative studies. The imaging quality was superior in assessment of shunts patency, myocardial perfusion, anastomotic patency and determining location of epicardial coronary arteries. They were lower in assessment of branch pulmonary arteries. Conclusion Intraoperative fluorescence angiography is a useful, and safe, technique that may provide a quick, on table assessment of a variety of congenital surgical procedures. This may help answers questions that minimize postoperative interventions, ensure smooth perioperative course and excellent outcomes.