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Coronary artery implantation is required for several congenital heart lesions/defects and is required during the arterial switch pro­cedure for transposition of the great vessels, during repair of anomalous left coronary artery from the pulmonary artery, and

All adequate images showed vessel or anastomotic site patency, which corresponded to the subsequent postoperative echocardio­grams and CT angiograms. They found that indocyanine green uorescent imaging provided an additional intraoperative imag­ing modality. It potentially will reduce the need for subsequent postoperative interventions, along with the associated morbidity and mortality.

Unfortunately, the current method of evaluation of surgical repair intraoperatively is limited echocardiogram, either trans­esophageal or epicardial. Although this modality is excellent for some lesions, there is frequently indirect or poor resolution of anatomy in others. In addition, the results are often subject to mis­interpretation due to operator dependency.

congenital heart surgery, especially when a ventriculotomy is planned, as the right ventricular outow tract reconstructions and biventricular repairs. Typically, major epicardial coronary arteries are easily identied during the rst-time operations. However, for intraoperative and re-operative surgeries, epicardial adhesions can obscure coronary vessels making the identication challenging.

A clear understanding of the coronary anatomy is critical in congenital heart surgery, especially during procedures requiring direct coronary manipulation, such as arterial switch operations for transposition of the great vessels. Further understanding of the coronary anatomy and course is also important when repairing lesions such as tetralogy of Fallot, where abnormal coronary pat­terns can dictate operative strategy (i.e., transannular repair versus RV to PA conduit) and primary (non-redo) surgery; the epicardial vessels are easily identied by direct inspection and injury that could be avoided in cases requiring ventriculotomy. In the re­operative setting however, the ability to precisely delineate epi­cardial coronary artery anatomy is more limited. Epicardial adhesions can obscure the heart surface anatomy rendering the epicardial coronary vessels less obvious, therefore placing them at high risk for injury during the ventriculotomy. Preoperative imaging of the coronary arteries has traditionally been accom­plished through several modalities including echocardiography, angiography, and the axial images with computer tomography and magnetic resonance imaging. All these can provide important anatomical information for preoperative planning; however, each has limitations in its ability to precisely dene coronary anatomy. In redo right ventricular outow tract (RVOT) reconstruction for tetralogy of Fallot and double-outlet right ventricle (DORV) and in complex biventricular repairs requiring intracardiac bafes and RV-PA conduits, the surgeon may be left questioning the exact location of epicardial vessels despite multiple preoperative imag­ing studies. In these cases, it is critical that the surgeon be able to precisely identify coronary arteries in order to avoid their injury when performing a ventriculotomy. To mitigate the risk of coro­nary artery injury, intraoperative uorescent imaging can be used to obtain real-time coronary artery imaging for the operative planning.