eComment. Extended sternal retraction and internal mammarian artery flow.

a serious concern and also demonstrated the importance of maintaining flow in the LIMA during grafting of the lateral and inferior wall of the myocardium. When a wide retraction of the sternum is necessary, the IMA flow may be compromised as shown in case 1 and as previously reported in a single patient operated with CPB [8]. It is important for the surgeon to be aware of this possible mechanism for the myocardial dysfunction when the myocardium is supplied by the IMA graft. If possible, a wide opening of the retractor during CABG surgery should be avoided. If the TTFM technology is available, the LIMA flow is easily measured when increasing the retractor opening. Although impairment of the IMA graft flow due to sternal retraction may be more serious in OPCAB, it may also be of importance in CABG performed with CPB. A wide opening of the sternum could reduce flow in the LIMA, which may result in ischaemia and thereby impede weaning from CPB. These mechanisms could cause similar challenges after weaning from CPB. The TTFM represents an easy and reproducible technique for the demonstration of inadequate flow in coronary grafts, and should always be considered in CABG surgery [9, 10]. The ultra-sound methodology used for monitoring of the regional myocar-dial contractility provides a sensitive tool for detecting ischaemia. In conclusion, we believe that the TTFM, transoesophageal echo-cardiography [11, 12] and miniaturized ultrasonic monitors placed directly on the epicardium [3, 13] may be useful instruments in the prevention of ischaemic complications during CABG. Automated detection of myocardial ischaemia by epicardial miniature ultrasound transducers—a novel tool for patient monitoring during cardiac surgery. Quantification of left ventricular systolic function by tissue Doppler echocardiography: added value of measuring pre-and postejection velocities in ischemic myocardium. Conversion and safety in off-pump coronary artery bypass: a system failure that needs re-emphasis. Conversion to cardiopulmonary bypass in off-pump coronary artery bypass grafting: its effect on outcome. Significant improvement in flow through a potential internal mammary graft after partial approximation of the sternum. Graft revision after transit time flow measurement in off-pump coronary artery bypass grafting. coronary graft flow measurement during reoperations for early graft failure after off-pump coronary revascularization. et al. Detection of ischemia and new insight into left ventricular physiology by strain Doppler and tissue velocity imaging: assessment during coronary bypass operation of the beating heart. Detecting myocardial ischaemia using miniature ultrasonic transducers— a feasibility …