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Coronary sinus injury during retrograde cardioplegia: a report of three cases
V R Kshettry1, C T Salerno, S Lakhanpal
1Division of Cardiovascular and Thoracic Surgery, University of Minnesota Hospital and Clinic, Minneapolis 55455, USA.
Insights
Coronary sinus injuries during retrograde cardioplegia are rare but can occur in patients with ventricular hypertrophy. Minimizing heart retraction and deflating the catheter during retraction can reduce injury risk.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
Background:
- Retrograde cardioplegia is a technique used to deliver heart-cooling solutions during cardiac surgery.
- Coronary sinus catheterization is essential for retrograde cardioplegia delivery.
- Injuries to the coronary sinus are infrequent complications.
Observation:
- This study reports three cases of coronary sinus injury during retrograde cardioplegia.
- These injuries occurred in patients with left ventricular hypertrophy.
- Manual retraction of the heart to expose the posterior myocardium was a contributing factor.
Findings:
- Coronary sinus injuries during retrograde cardioplegia are associated with left ventricular hypertrophy.
- Overinflation of the coronary sinus catheter balloon and traumatic insertion are common causes.
- Manual heart retraction increases the risk of injury in hypertrophied hearts.
Implications:
- Avoiding excessive heart retraction during retrograde cardioplegia can minimize injury risk.
- Deflating the retrograde catheter during manual heart retraction is a recommended safety measure.
- Utilizing a left ventricular vent may further reduce the potential for coronary sinus injury.
Abstract:
Coronary sinus injuries related to the use of retrograde cardioplegia are uncommon. In most cases injuries are encountered with overinflation of the coronary sinus catheter balloon or traumatic catheter insertion. This article describes three cases of coronary sinus injury during retrograde cardioplegia administration in patients with ventricular hypertrophy, while the heart was manually retracted to expose the posterior myocardium. We propose that the risk of coronary sinus injury during retrograde cardioplegia, in patients with left ventricular hypertrophy, can be minimized by avoiding excessive retraction of the heart, deflation of the retrograde catheter during retraction, and the use of a left ventricular vent.