High-frequency ultrasound-guided late surgical revascularisation of chronically occluded left anterior descending coronary artery.

A few successful reports exist of late revascularisation of an 'occluded' left anterior descending coronary artery (LAD) with no angiographically visible collateral circulation. Epicardial high-frequency ultrasound and colour Doppler mapping can directly provide accurate anatomical landmarks and also detect very slow coronary flow velocities, with greater sensitivity than coronary angiograms. Late revascularisation of a chronically occluded LAD was performed successfully in two diabetic patients using high-frequency epicardial echo guidance. This had a positive effect on the left ventricular ejection fraction in the hibernating myocardial segments, and there were no subsequent cardiac events as well. These results indicate that the poor prognosis in diabetic patients with very severely reduced left ventricular function and reduced myocardial viability may be improved by late surgical revascularisation of chronic total occlusion (CTO) with no retrograde collateral channel.