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The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 1066-1076, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
MC Stirling, TB McClanahan, RJ Schott, MJ Lynch, SF Bolling, MM Kirsh and KP Gallagher
The adequacy of retrograde delivery of cardioplegic solution to the right
ventricle and interventricular septum is controversial. To address this
issue quantitatively, we infused blood cardioplegic solution labeled with
radioactive microspheres (15 microns diameter) into the coronary sinus (n =
8 dogs) at a pressure of 51 +/- 1 mm Hg (mean +/- standard error of the
mean) to be compared with the same quantity of labeled cardioplegic
solution (20 ml/kg) delivered through the aorta (n = 6 dogs) at 97 +/- 7 mm
Hg. Both methods of delivery produced cardiac arrest, but retrograde
infusion required a significantly longer time to complete the infusion (6.2
+/- 0.8 minutes versus 1.5 +/- 0.1 minutes, p less than 0.01). Greater than
99% of the microspheres passing through the vasculature of the left
ventricle were trapped in the left ventricular myocardium with antegrade
infusion, and the distribution of the cardioplegic solution was uniform.
Antegrade delivery (cardioplegic flow x infusion time) averaged
approximately 3.0 to 4.0 ml/gm, except at the apex, where delivery averaged
approximately 2.0 ml/gm. With retrograde infusion, 93% of the microspheres
perfusing the left ventricle were trapped and delivery of the cardioplegic
solution was not uniform. In the anterolateral free wall, delivery of
cardioplegic solution averaged between 1.5 and 2.9 ml/gm (p less than 0.001
compared with antegrade) and only 0.6 to 0.8 ml/gm in the posteroseptal
region of the basal left ventricle (p less than 0.001 compared with the
antegrade group and anterolateral samples of the retrograde group). In the
middle portion of the right ventricle, antegrade trapping of microspheres
was 99% and delivery of cardioplegic solution averaged approximately 2.0
ml/gm. With retrograde delivery, only 16.5% (range 11.8% to 26.0%) of the
microspheres passing through the right ventricular vasculature were trapped
in the right ventricular myocardium, which indicates that substantial
shunting had occurred. Corrected for the high shunt fraction, retrograde
delivery of cardioplegic solution to the middle portion of the right
ventricle averaged only 0.5 ml/gm (p less than 0.01). Retrograde delivery
to the atrial septum and right atrium was also low. Because retrograde
delivery of cardioplegic solution was markedly nonuniform, we conclude that
inadequate cardioplegic delivery to the middle portion of the right
ventricle and posteroseptal portion of the left ventricle could result with
cardioplegic infusion through the coronary sinus.
ARTICLES
Distribution of cardioplegic solution infused antegradely and retrogradely in normal canine hearts
Department of Surgery (Thoracic Section) University of Michigan Medical, School Ann Arbor 48109.
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