HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Brian M. Fabri J. Nilas Young Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fabri, B. M. Articles by Young, J. N. Search for Related Content PubMed PubMed Citation Articles by Fabri, B. M. Articles by Young, J. N.

Ann Thorac Surg 1997;64:292
© 1997 The Society of Thoracic Surgeons

---

Correspondence

Antegrade Cardioplegia Pressure Monitoring

The Cardiothoracic Centre-Liverpool, Nhs Trust, Thomas Dr, Liverpool L14 3pe, England.

To the Editor:

We read with interest the recent article by Young and Choy [1] regarding aortic root pressure monitoring for the administration of cardioplegia. Since 1990 we have been employing normothermic techniques for myocardial protection [2, 3]. Although at present continuous, retrograde delivery is our preferred mode of administration, the solely antegrade route was used extensively during our initial experience. We still use continuous, antegrade cardioplegia in instances of patients requiring one or two grafts, particularly in the left anterior descending and right coronary regions or closure of secundum atrial septal defects. During continuous delivery, monitoring of aortic root pressure is essential. High pressures (>100 mm Hg) cause difficulty with visualization and may lead to myocardial edema. On the other hand, low delivery pressures (<50 mm Hg) will result in inadequate myocardial perfusion or left ventricular distention due to aortic valve incompetence (native or iatrogenic).

We agree that "in-line" pressure monitoring is grossly inaccurate and the pressure measured is usually many times higher than the true luminal pressure. Because of this concern we have used a commercially available double-lumen, central venous catheter (MultiCath double lumen vascular catheter, Vygon, France) for the administration of antegrade blood cardioplegia with simultaneous aortic root pressure measurement. The catheter is made of polyurethane and is 11 cm long. There is a 12-gauge lumen at the tip and a smaller (19-gauge) lumen opening as a side-hole 2 cm from the tip. When placed inside the aortic root the smaller, proximal hole acts as the pressure-monitoring channel, while the larger, distal channel is used for cardioplegia delivery allowing for a maximal flow rate of 220 mL/min. During continuous, antegrade cardioplegia we monitor the aortic root pressure closely, maintaining it at 70 to 100 mm Hg, which usually leads to a flow rate of 80 to 150 mL/min.

Since 1990 we have used this catheter in more than 340 patients in whom continuous, warm, antegrade cardioplegia was the preferred mode of myocardial protection. It is easy to insert using the supplied puncture needle (18-gauge) and guidewire and adopting a modified Seldinger technique. We agree with Drs Young and Choy that direct intraaortic pressure should be monitored during antegrade delivery of cardioplegia and recommend it especially if a continuous technique is adopted. We wish to draw the readership's attention to a commercially available device that we have found suitable for use in adult patients.

References

1. Young JN, Choy IO. Aortic root pressure monitoring during antegrade cardioplegia administration. Ann Thorac Surg 1996;62:1213–4.[Abstract/Free Full Text]
2. Page RD, Sharpe DA, Bellamy CM, Rashid A, Fabri BM. Normothermic arrest with continuous hyperkalaemic blood: initial experience. Eur J Cardiothorac Surg 1992;6:461–8.[Abstract]
3. Steyn RS, Page RD, Meadows GA, Rashid A, Fabri BM. Cardioplegia delivery during continuous normothermic cardiopulmonary bypass [Letter]. Ann Thorac Surg 1993;56:1214–5.

Reply

Cardiothoracic Surgery, Children's Hospital Oakland, 747 Fifty-Second St, Oakland, Ca 94609-1809.

To the Editor:

My colleagues and I appreciate the comments of Dr Fabri and Dr Fox, and were interested to review their experience with aortic root pressure monitoring during antegrade cardioplegia delivery. We believe that monitoring is extremely important, and would agree it is essential when using continuous warm cardioplegia techniques. Their catheter device appears quite satisfactory, albeit somewhat a little more involved than the one we use (Cook, Inc, Bloomington, IN), which requires only a needle stylet for insertion. Additionally, the double-lumen catheter we use has been modified for not only the adult but the pediatric and neonatal age groups, in which the use of the Seldinger technique, as used by Drs Fabri and Fox, might be a bit more cumbersome.

This article has been cited by other articles:

				M. Ricci, H. L. Karamanoukian, M. R. Jajkowski, G. D'Ancona, J. Bergsland, and T. A. Salerno The innominate artery as an inflow site in coronary reoperations without cardiopulmonary bypass Ann. Thorac. Surg., May 1, 2000; 69(5): 1606 - 1608. [Abstract] [Full Text] [PDF]

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Brian M. Fabri J. Nilas Young Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fabri, B. M. Articles by Young, J. N. Search for Related Content PubMed PubMed Citation Articles by Fabri, B. M. Articles by Young, J. N.