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Ann Thorac Surg 2004;78:757-758
© 2004 The Society of Thoracic Surgeons

Correspondence

Retained cuff of retrograde cardioplegia cannula in the coronary sinus

Dilip Oswal, MCh, FRCSI

71 Tinshill Lane, Leeds, LS16 6DF, UK

Sharan Hallad, MS, MCh, Shrikant D. Kole, MS, MCh

CVTC, Civil Hospital, Kolhapur, 416 002, India

e-mail: diliposwal{at}hotmail.com
e-mail: sdkole{at}vsnl.com

To the Editor:

An adult woman with aortic regurgitation and mitral stenosis was taken for aortic and mitral valve replacement. The superior vena cava and inferior vena cava were cannulated separately.

A 13F Medtronic DLP (Medtronic Inc, Minneapolis, MN) retrograde cardioplegia cannula was inserted via a purse-string stitch placed on the right atrium into the coronary sinus. The position was checked by palpating the cuff in the coronary sinus from outside. Normothermic blood cardioplegic arrest was achieved by using antegrade cardioplegia delivered directly into the coronary ostia. Thereafter multidose retrograde cardioplegia was given at 20-minute intervals. The retrograde cardioplegia delivery was at 100 to 150 mL/min for 3 minutes each. The coronary sinus pressure during its delivery was kept between 25 and 35 mm Hg.

On removal of the retrograde cardioplegia cannula towards the end of the procedure, it was noted that the cuff at the tip was missing. It could be felt in the coronary sinus. The patient was still on cardiopulmonary bypass. Both the cavae were taped and snugged. The right atrium was opened with an oblique incision. The end of the cuff was seen in the coronary sinus and this was gently extracted with forceps. It came out without any resistance (Fig 1). There was no evidence of injury to the coronary sinus from inside or outside. The right atrium was repaired. The remaining operation proceeded in an uneventful manner.



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  		Fig 1. The detached cuff of the retrograde cardioplegia cannula.

 
The use of retrograde cardioplegia has increased in recent years. However, such a complication has occurred for the first time in our experience over the last 12 years. We are not aware of such a complication being reported elsewhere. This problem would be more difficult in the setting of coronary bypass surgery, in which retrograde cardioplegia is more commomly used. This is because of the single venous (cavo atrial) cannula. In this situation, the surgeon may choose to convert this to bicaval cannulation and then open the right atrium. It is worth emphasizing that force should not be applied, not only while inserting the retrograde cannula, but also while removing it. However, in this case, it remains unclear as to what exactly caused the detachment of the cuff from the cannula.





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