J Thorac Cardiovasc Surg 2007;134:826
© 2007 The American Association for Thoracic Surgery
Iatrogenic coronary stenosis
Hendrick Boyer Barner, MD
Division of Cardiothoracic Surgery, St Louis University, St Louis, Mo
To the Editor:
Maltais and associates have reminded us of the hazard of selective antegrade coronary perfusion with an intracoronary cannula, which is occasionally appropriate despite the utility of retrograde cardioplegia.1
Working with DLP Inc. in 1984, we developed a noncannulating coronary cannula to avoid trauma to the ostium and the proximal coronary artery.2 The recessed tip is surrounded by a silicone rubber bumper to achieve a seal between the cannula and the aortic wall (Figure 1). If there is calcification of the aortic wall adjacent to the ostium, a seal may not be possible and a second tip, which is convex rather than concave, may be effective and is likely associated with minimal trauma to the ostium (Figure 2). Although the advent of retrograde cardioplegia has greatly reduced the need for direct coronary infusion of cardioplegia, there may be poor delivery of retrograde cardioplegia to the right ventricle and perfusion of the right ostium with this cannula is appropriate. When it is necessary to perfuse previously placed vein grafts, the cannula is also effective. I am not aware of publications supporting the usefulness or safety of this device, but its continued availability from Medtronic Inc. after 20 years suggests that it has a market, and anecdotal communications to me confirm its utility.
View larger version (75K):
[in this window]
[in a new window]
|
Figure 1. The shaft of the cannula is malleable for optimal positioning with a proximal luer-lok for the cardioplegia line. The tip is recessed within the silicone rubber bumper to avoid ostial trauma.
|
|
View larger version (45K):
[in this window]
[in a new window]
|
Figure 2. Several tip configurations are available, but the concave tip is unlikely to injure the ostium, whereas the convex could possibly do so and the basket tip is more likely to do so.
|
|
References
- Maltais S, El-Hamamsy I, Ducharme A, Carrier M, Pellerin M, Perrault LP. Late iatrogenic coronary stenosis after selective intraoperative myocardial protection for stentless aortic valve replacement. J Thorac Cardiovasc Surg 2006;132:420-421.[Free Full Text]
- Barner HB. A noncannulating coronary perfusion cannula. J Thorac Cardiovasc Surg 1986;92:961-962.[Abstract]
