Intraoperative coronary angiography: With or without ischemia?

We read with interest the article by Kilian and coworkers1 entitled ‘‘Intraoperative coronary angiography in the management of patients with acute aortic dissection and endocarditis.’’ The authors describe the possibility of performing an intraoperative angiographic assessment of the coronary arteries in patients with potential contraindications to the conventional preoperative cardiac catheterization in the catheterization laboratory. In fact, in patients presenting with acute aortic dissection, the diagnosis is usually accomplished by means of computed tomographic scanning and transesophageal echocardiographic analysis, and the patient is immediately moved to the operating room for emergency surgical intervention.