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The Annals of Thoracic Surgery, Vol 50, 882-886, Copyright © 1990 by The Society of Thoracic Surgeons
SR Gundry, A Sequiera, AM Razzouk, JS McLaughlin and LL Bailey
The benefits of coronary sinus (CS) cardioplegia are well known, yet CS
cardioplegia is not used widely owing to the need for bicaval cannulation,
snares, and an atriotomy. We designed and used in 225 consecutive patients
a catheter containing a flexible removable stylet that, when shaped into a
hockey-stick configuration, enabled blind intubation of the CS through a
small pursestring in the right atrium, guided easily into the CS using a
finger on the atrioventricular groove at the inferior vena cava. The CS was
intubated in all patients; a pressure-limited balloon at the catheter tip
was inflated after cross- clamping. An integral distal pressure line
measured CS pressure. Catheters were placed distally within the great
cardiac vein beyond the posterior interventricular vein; the position did
not alter cooling: right ventricular free wall, septum, and left
ventricular free wall temperatures were 7 degrees +/- 2 degrees, 8 degrees
+/- 2 degrees, and 7 degrees +/- 2 degrees C, respectively, after an
initial 10 mL/kg of blood cardioplegia. Transatrial CS cardioplegia was
used in 45 aortic valve replacements, 22 mitral valve replacements, 4
triple-valve replacements, 6 congenital lesions, and 148 coronary
revascularizations, including 40 redo operations. Atheromatous material was
routinely flushed retrogradely from cut old vein grafts during
revascularization; 70 revascularizations (47%) were performed urgently for
acute infarction or jeopardized myocardium. No heart block or CS injury
occurred, and inotrope use dropped to 10% of patients (from 38% in the
previous 256 patients with antegrade blood cardioplegia). We conclude that
the CS can be cannulated transatrially and that CS cardioplegia is more
facile than antegrade cardioplegia.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Facile retrograde cardioplegia: transatrial cannulation of the coronary sinus
Department of Surgery, Loma Linda University Medical Center, California 92354.
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