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J Thorac Cardiovasc Surg 1996;111:683
© 1996 Mosby, Inc.

LETTERS TO THE EDITOR

Improved distribution of retrograde cold cardioplegic solutions

Noel H. Fishman, MD

Department of Cardiothoracic Surgery
Dominican Hospital
1575 Soquel Dr.
Santa Cruz, CA 95065

To the Editor:

In a recent article in this Journal, Rudis, Gates, and LaksGo 1 showed conclusively that retrograde coronary sinus perfusion solutions may be distributed unevenly and leave the right ventricle inadequately protected as a result. They corrected this inhomogeneity of perfusion by occluding the coronary ostium with a purse-string suture, thereby preventing reflux and decompression of coronary veins proximal to the self-inflating balloon.

Most surgeons have probably noticed that the coronary veins closest to the coronary sinus ostium are often not fully distended during intermittent retrograde perfusion of cold cardioplegic solutions. Furthermore, the right ventricle remains relatively warm. However, when the ostium of the coronary sinus is occluded by digital compression (at the junction of the right atrium and inferior vena cava), all of the coronary veins become distended and the right ventricle becomes cold immediately. The rate of flow must usually be reduced to avoid excessive perfusion pressures to compensate for the elimination of reflux.

Other technical strategies, such as double balloon catheters, may achieve the same purpose, but the method described here is safe, simple, and inexpensive, and it adds only 3 or 4 minutes to the average cardiopulmonary bypass time.

References

  1. Rudis E, Gates N, Laks H. Coronary sinus ostial occlusion during retrograde delivery of cardioplegic solution significantly improves cardioplegic distribution and efficacy. J THORAC CARDIOVASC SURG 1995;109:941-7.[Abstract]




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