Potential risks in retrovenous revascularization of the myocardium

Retrovenous perfusion of the myocardium via the coronary sinus and cardiac veins was one of the earliest attempted forms of myocardial revascularization. Although coronary artery revascularization has almost completely replaced venous revascularization as the procedure of choice, the latter approach is still occasionally performed. We present two cases of hemorrhage within viable and nonviable myocardium noted at autopsy in patients who had undergone retrovenous revascularization hours before death. The two cases illustrate a complication of this procedure that has not previously been emphasized.