Document Detail

Facile retrograde cardioplegia: transatrial cannulation of the coronary sinus.
MedLine Citation:
PMID:  2241379     Owner:  NLM     Status:  MEDLINE    
The benefits of coronary sinus (CS) cardioplegia are well known, yet CS cardioplegia is not used widely owing to the need for bicaval cannulation, snares, and an atriotomy. We designed and used in 225 consecutive patients a catheter containing a flexible removable stylet that, when shaped into a hockey-stick configuration, enabled blind intubation of the CS through a small pursestring in the right atrium, guided easily into the CS using a finger on the atrioventricular groove at the inferior vena cava. The CS was intubated in all patients; a pressure-limited balloon at the catheter tip was inflated after cross-clamping. An integral distal pressure line measured CS pressure. Catheters were placed distally within the great cardiac vein beyond the posterior interventricular vein; the position did not alter cooling: right ventricular free wall, septum, and left ventricular free wall temperatures were 7 degrees +/- 2 degrees, 8 degrees +/- 2 degrees, and 7 degrees +/- 2 degrees C, respectively, after an initial 10 mL/kg of blood cardioplegia. Transatrial CS cardioplegia was used in 45 aortic valve replacements, 22 mitral valve replacements, 4 triple-valve replacements, 6 congenital lesions, and 148 coronary revascularizations, including 40 redo operations. Atheromatous material was routinely flushed retrogradely from cut old vein grafts during revascularization; 70 revascularizations (47%) were performed urgently for acute infarction or jeopardized myocardium. No heart block or CS injury occurred, and inotrope use dropped to 10% of patients (from 38% in the previous 256 patients with antegrade blood cardioplegia). We conclude that the CS can be cannulated transatrially and that CS cardioplegia is more facile than antegrade cardioplegia.(ABSTRACT TRUNCATED AT 250 WORDS)
S R Gundry; A Sequiera; A M Razzouk; J S McLaughlin; L L Bailey
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  50     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1990 Dec 
Date Detail:
Created Date:  1990-12-26     Completed Date:  1990-12-26     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  882-6; discussion 886-7     Citation Subset:  AIM; IM    
Department of Surgery, Loma Linda University Medical Center, California 92354.
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MeSH Terms
Aged, 80 and over
Blood Pressure
Body Temperature
Cardioplegic Solutions / administration & dosage
Child, Preschool
Coronary Vessels* / anatomy & histology
Equipment Design
Heart / physiology
Heart Arrest, Induced / instrumentation,  methods*
Heart Atria
Heart Catheterization / instrumentation,  methods*
Heart Valve Prosthesis
Middle Aged
Myocardial Revascularization
Reg. No./Substance:
0/Cardioplegic Solutions

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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