title: Percutaneous Coronary Sinus Catheterization With the ProPlege Catheter Under Transesophageal Echocardiography and Pressure Guidance.
abstract: OBJECTIVE
  Percutaneous catheterization of the coronary sinus (CS) to enable the administration of retrograde cardioplegia may play an important role in minimally invasive cardiac surgery. A new specially designed device (ProPlege; Edwards Lifesciences, Irvine, CA) is described that can be placed under transesophageal echocardiography (TEE) and pressure guidance with a high rate of success and low rate of complications.
  
  
  METHODS
  Case series.
  
  
  METHODS
  A university-affiliated private hospital.
  
  
  METHODS
  Patients undergoing minimally invasive cardiac surgery.
  
  
  METHODS
  The ProPlege device was placed under TEE and pressure guidance only.
  
  
  RESULTS
  Records of 70 patients managed with ProPlege were reviewed and analyzed. Successful placement was attained in 69 patients (98.6%) as confirmed by the ventricularization of the CS pressure curve and TEE images. Direct imaging of the ProPlege tip was possible in 34 patients (49.2%). The capacity to generate a CS pressure>30 mmHg during retrograde cardioplegia administration at a flow>150 mL/min was obtained in 64 patients; ProPlege displacement occurred in 5 cases (7.2%). Successful retrograde cardioplegia was delivered in 91.4% of cases. No CS perforation or other injuries to the right heart were noted at intraoperative TEE or direct surgical inspection.
  
  
  CONCLUSIONS
  Percutaneous CS catheterization with ProPlege was performed with a high rate of success for positioning and low complication rate using TEE and pressure guidance only. Further studies are needed to more accurately determine complication rates and to establish the possible complementary role of fluoroscopy.
authors.affiliation: Departments of Cardiac Anesthesia and. Electronic address: dino.labriola@gmail.com.
authors.forename: Cataldo
authors.initials: C
authors.lastname: Labriola
authors.affiliation: Departments of Cardiac Anesthesia and.
authors.forename: Francesco
authors.initials: F
authors.lastname: Greco
authors.affiliation: Cardiac Surgery, "Santa Maria" Hospital, Bari, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Braccio
authors.affiliation: Departments of Cardiac Anesthesia and.
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Dambruoso
authors.affiliation: Cardiac Surgery, "Santa Maria" Hospital, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Labriola
authors.affiliation: Department of Cardiac Surgery, University Hospital, Bari, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Paparella
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D062906:Cardiac Catheters; D054326:Coronary Sinus / Q000000981:diagnostic imaging* / Q000601:surgery; D017548:Echocardiography, Transesophageal / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011312:Pressure; D012189:Retrospective Studies
keywords: coronary sinus; echocardiography; minimally invasive cardiac surgery; myocardial protection