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Right ventricular protection with coronary sinus retrograde cardioplegia
Author(s) -
Sutter Francis P.,
Nielson David H.,
Goldman Scott M.,
Mitchell John M.,
Garwood Alexander P.,
King Sheila,
Gallagher Joseph F.,
Clancy Michael
Publication year - 1994
Publication title -
clinical anatomy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.667
H-Index - 71
eISSN - 1098-2353
pISSN - 0897-3806
DOI - 10.1002/ca.980070505
Subject(s) - coronary sinus , medicine , ventricle , cardiology , cardiopulmonary bypass , right atrium , collateralization , perfusion , retrograde perfusion , venous blood , anesthesia , collateral , finance , economics
Fifteen consecutive patients having open heart surgery using retrograde cardioplegia were studied to demonstrate that important venous collateralization exists between the coronary sinus (CS) and its left ventricular branches and the right ventricle (RV). The venous collateralization makes possible RV myocardial protection during retrograde cardioplegia. Right ventricular venous drainage principally occurs via anterior cardiac veins, which drain into the right atrium, and thebesian veins, which drain into both the RV and the atrium, generally without connection to the CS. Retrograde cardioplegia used during open heart surgery should, therefore, give inadequate myocardial protection to the RV. Two RV temperature probes used as markers for RV perfusion were monitored continuously during cardiac arrest. Systemic temperature while on cardiopulmonary bypass was 25°C, and the retrograde perfusate solution temperature was 4°C. Coronary sinus pressure during the bypass procedure was maintained between 20 torr and 50 torr. Mean temperatures at the two probe sites were 16.1°C and 14.5°C. We conclude that a complex network of venous collaterals between the coronary sinus and left ventricle and the right ventricle allow excellent myocardial protection during retrograde cardioplegia. © 1994 Wiley‐Liss, Inc.