Coronary sinus rupture with retrograde cardioplegia
Mark Kurusz1, Mark K Girouard, Paul S Brown
1Division of Cardiothoracic Surgery, The University of Texas Medical Branch, Galveston 77555-0528, USA. mkurusz@utmb.edu
Perfusion
|January 31, 2002
Summary
Coronary sinus rupture during retrograde cardioplegia is a rare but serious complication, particularly in patients with left ventricular hypertrophy. Monitoring infusion pressures and the coronary sinus waveform during retrograde cardioplegia is crucial for early detection and intervention.
Area of Science:
- Cardiac Surgery
- Cardiology
- Cardiopulmonary Bypass
Background:
- Retrograde cardioplegia (RCP) is used for myocardial protection during cardiac surgery.
- Coronary sinus (CS) rupture is a rare complication associated with RCP.
- Left ventricular hypertrophy increases the risk of CS injury.
Observation:
- A 66-year-old female with significant cardiac history experienced CS rupture during RCP administration.
- Sudden drop in CS pressure indicated a complication, leading to hematoma formation and subsequent rupture.
- Initial repair with a pericardial patch failed, and the friable tissue prevented further salvage.
Findings:
- The patient developed a CS rupture during RCP due to inadequate myocardial cooling with antegrade cardioplegia.
- The rupture was initially managed with a pericardial patch, but persistent bleeding occurred.
- Tissue friability and dissociation of the ventricle prevented successful repair, leading to a non-salvageable situation.
Implications:
- Perfusionists must closely monitor CS infusion pressures and waveforms during RCP.
- Abnormal waveforms may signal cannula issues or CS rupture, necessitating immediate cessation of RCP.
- This case highlights the critical need for vigilance and prompt response to potential complications during RCP.
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