Rare complication of retrograde cardioplegia: inner wall perforation of the right atrium

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Reduction of Iatrogenic Atrial Septal Defects with an Anterior and Inferior Transseptal Puncture Site when Operating the Cryoballoon Ablation Catheter
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G W He1

  • 1Department of Surgery, University of Hong Kong, Grantham Hospital, Aberdeen, Hong Kong.

The Annals of Thoracic Surgery
|February 1, 1997
PubMed

Insights

Retrograde cardioplegia delivery can be complicated by cannula misplacement. Surgeons must be cautious of right atrial wall penetration, especially in dilated atria, to ensure effective cardiac protection.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Anesthesia
  • Thoracic Surgery

Background:

  • Retrograde cardioplegia is a standard technique for myocardial protection during cardiac surgery.
  • Ensuring proper cannula placement in the coronary sinus is crucial for effective cardioplegia delivery.

Observation:

  • A case is presented where the retrograde cannula inadvertently penetrated the right atrial wall instead of entering the coronary sinus.
  • This complication occurred due to the cannula tip lodging in enlarged intertrabecular spaces within a dilated right atrium.

Findings:

  • Penetration of the right atrial wall by the retrograde cannula compromises the delivery of cardioplegia to the myocardium.
  • Friable atrial tissue and enlarged spaces in dilated right atria increase the risk of such malpositioning.

Implications:

  • Surgeons must exercise heightened vigilance for potential cannula malposition during retrograde cardioplegia, particularly in patients with atrial dilation.
  • Awareness of this complication is essential for preventing impaired myocardial protection and optimizing surgical outcomes.

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