Coronary sinus catheter placement: assessment of placement criteria and cardiac complications.
OBJECTIVE
To evaluate the placement and complications of a coronary sinus (CS) catheter in human subjects.


METHODS
Sixty-two CS catheters inserted in patients scheduled for coronary artery bypass graft surgery (CABG).


METHODS
University hospital, anesthesia and cardiothoracic surgery departments.


METHODS
Sixty-two patients without valvular or concomitant diseases undergoing CABG.


METHODS
CS fluoroscopy, measurements of CS flow, CS oxygen saturation, and CS distal tip pressure before incision, after incision, 20 min after aortic cross-clamp release (X-off), 50 min after X-off, 2 h after X-off, 4 h after X-off, and 6 h after X-off.


RESULTS
In 57 patients (92%), we achieved successful CS catheter placement. In five patients (8%), CS catheter positioning was not possible. Of the 57 CS catheters placed, dislocation occurred during the operation in six patients (11%) and postoperatively in three patients (6%). Cardiac complications of CS catheter placement occurred in nine patients (15%). Four patients (6%) acquired hemopericardium. Three of these patients had a small hematoma in the right ventricle. In two other patients, contrast medium appeared in the right ventricular wall during catheterization. No hemodynamic signs of these complications were detected clinically. Irregular heart rhythm was observed in only three patients. CS blood oxygen saturation ranged from 40 to 60%. CS flow amounted to 3% of cardiac output. Variations in CS flow paralleled changes in cardiac output.


CONCLUSIONS
A CS catheter is a useful tool for clinical human cardiac research; however, the placement of a CS catheter can cause minor myocardial damage in > 10% of patients. Importantly, this damage may not be clinically evident, but only observed after thoracotomy. CS oxygen saturation, CS flow, distal tip pressure, and fluoroscopy are reliable tools to assess a safe and correct positioning of the CS catheter.
Langenberg
Chris J M
CJ
Department of Anesthesiology, Jeroen Bosch Ziekenhuis, Hertogenbosch, The Netherlands. clan@wish.net
Pietersen
Henk G
HG
Geskes
Gijs
G
Wagenmakers
Anton J M
AJ
Soeters
Peter B
PB
Durieux
Marcel
M
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D002404:Catheterization; D003331:Coronary Vessels; D005260:Female; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged