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Ann Thorac Surg 1991;52:810-814
© 1991 The Society of Thoracic Surgeons

Articles

Assessment of retrograde cardioplegia distribution using contrast echocardiography

Solomon Aronson, MD, Bryan K. Lee, MD*, John R. Liddicoat, MD, Jeff G. Wiencek, BS, Stephen B. Feinstein, MD, John E. Ellis, MD, Michael F. Roizen, MD, Robert B. Karp, MD

Section of Cardiac Surgery and Department of Anesthesia and Critical Care, University of Chicago, Pritzker School of Medicine, Chicago, Illinois USA

Accepted for publication May 20, 1991.

* Address reprint requests to Dr Lee, Section of Cardiac Surgery, Department of Surgery, Box 152, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL 60637.

Retrograde cardioplegia has gained popularity in coronary and noncoronary cardiac operations. We have used contrast echocardiography in the open-chest canine model to compare the distribution of cardioplegia delivered antegrade in the aortic root versus retrograde through the coronary sinus, and to determine the effect of coronary occlusion on that delivery. With no coronary occlusion, antegrade cardioplegia was distributed to the entire left ventricle and septum whereas retrograde cardioplegia was distributed to the left ventricular free wall but had inconsistent delivery to the septum. Acute occlusion of the left circumflex coronary artery resulted in 57.06% ± 9.52% of the left ventricle not being perfused by antegrade cardioplegia and occlusion of both the left circumflex and anterior descending coronary arteries caused a 65.46% ± 18.5% reduction in perfusion by antegrade cardioplegia. Acute coronary occlusion had no effect on retrograde cardioplegia distribution. We conclude that retrograde cardioplegia is less homogeneous than antegrade cardioplegia in the intact coronary circulation but that retrograde cardioplegia preserves cardioplegia distal to acutely occluded coronary arteries. Furthermore, contrast echocardiography is a useful method of assessing myocardial perfusion and may have useful clinical applications.




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