Visualization of ostial lesions of native coronary arteries and saphenous vein bypass grafts by intracardiac echocardiography

The feasibility of visualizing ostial lesions of native coronary arteries and saphenous vein grafts in humans using intracardiac echocardiography (ICE) was investigated. A size 8 French, low frequency (10 MHz), catheter type intracardiac ultrasound probe was used in 31 patients with diseased native coronary arteries or saphenous vein grafts. The ICE catheter probe could be placed easily in the aortic root retrogradely using a specially designed long sheath. The right coronary artery was visualized in 28 (90%), and the left coronary artery in 21 (68%) patients. Twenty saphenous vein grafts (angiographically 12 were patent, and 8 were occluded) were also evaluated in 8 patients: all angiographically patent grafts were visualized (12/12 = 100%), and 5 of the occluded grafts (5/8 = 63%). No complications were observed. A stenotic atheromatous lesion of the right coronary artery ostium was visualized in 7 patients, and in 2 of them its complete removal by directional coronary atherectomy could be corroborated. Thus, ICE is useful for evaluation of ostial lesions, particularly of the right coronary artery, as well as saphenous vein grafts attached to the anterior aspect of the aortic wall. It could probably be used as a guiding tool during catheter interventions directed at ostial lesions.