[Pressure monitoring of the coronary sinus during retrograde cardioplegia].
Though the retrograde perfusion via the coronary sinus is a useful way of myocardial protection for more complicated cardiac surgery, coronary venous injury and inadequate preservation of the right ventricle were considered to be disadvantageous. In order to deal effectively with these problems we made a 3-way balloon catheter (Retro-Higami type 12 Fr) and evaluated the importance of monitoring the perfusion pressure in the coronary sinus in 214 patients. The mean perfusion pressure during retrograde cardioplegia infused by a pump was 29.4 +/- 9.1 mmHg, and had significant relation to the left ventricular mass weight (LVMW) which was calculated by UCG method. High perfusion pressure above 40 mmHg, which could have induced coronary venous injury, was noticed in 24 patients, but proper countermeasures could avoid venous injury completely. In 16 of those the high perfusion pressure was due to inadequate position of a tip of the catheter, and in other 8 it was due to relatively high flow rate of cardioplegic solution to LVMW. Twenty-eight patients showed low perfusion pressures below 20 mmHg, due mainly to the leakage from the orifice of the coronary sinus. The coronary sinus pressure during continuous gravity retroperfusion which was 9.2 +/- 2.6 mmHg seemed to bring optimal delivery of cardioplegic solution to the myocardium. On the basis of the results obtained from this clinical study we conclude that the monitoring of coronary sinus pressure during retroperfusion is useful not only to avoid coronary venous injury but to maintain adequate perfusion.
Higami
T
T
Division of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan.
Ogawa
K
K
Asada
T
T
Mukohara
N
N
Nishiwaki
M
M
D000328:Adult; D000368:Aged; D002314:Cardioplegic Solutions / Q000008:administration & dosage; D003331:Coronary Vessels / Q000503:physiopathology*; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010477:Perfusion / Q000379:methods; D014680:Veins / Q000503:physiopathology; D014690:Venous Pressure
D002314:Cardioplegic Solutions