Management of catheter-related injuries to the coronary sinus.
BACKGROUND
Although coronary sinus catheter-related injuries (CSCRIs) are rare, they are potentially lethal. The purpose of this study was to evaluate such injuries, the repair methods used, and to identify related risk factors for mortality.


METHODS
A retrospective review of 10,552 cardiac surgical procedures from 1995 to 2000 in which retrograde cardioplegia was used revealed 10 cases (n = 10) of CSCRIs (0.095%) at our center. These injuries occurred during coronary bypass, valve replacement, and combined procedures. Management included direct suture, vein patch, or pericardial "on-lay" patch repair.


RESULTS
Two deaths occurred (20% mortality) from failure of CSCRI repair; 8 of 10 injuries (80%) were successfully repaired. One patient had delayed, localized pericardial tamponade, which resolved spontaneously. Two patients had recurrent angina that was assessed 3 and 5 years later by coronary angiography; the coronary sinus was found to be patent in both cases. The remaining 6 patients have been asymptomatic.


CONCLUSIONS
Repair of CSCRIs can be challenging as it can be complicated by inadequate myocardial protection, inadvertent coronary artery injuries, and possibly, subsequent coronary sinus thrombosis. Repair of CSCRIs should be carried out on an arrested, well-protected heart providing secure hemostasis and coronary sinus patency.
Economopoulos
George C
GC
Division of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece. geconomo@otenet.gr
Michalis
Alkiviadis
A
Palatianos
George M
GM
Sarris
George E
GE
D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D003327:Coronary Disease / Q000601:surgery; D003331:Coronary Vessels / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007049:Iatrogenic Disease; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis