Know the Guard of Coronary Sinus Before Cannulation

Raut, Monish S; Maheshwari, Arun; Shad, Sujay

doi:10.1053/j.jvca.2016.05.041

Cited by 1 publication

(1 citation statement)

References 15 publications

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“…Although insertion of a CS cannula can be facilitated and confirmed using fluoroscopic guidance and pressure waveform analysis, perioperative real-time TEE has the benefit of providing continuous visualization of both the CS and CS cannula without the need for contrast or radiation exposure [ 7 ] and can both reduce the risk of CS injury [ 13 ] and detect complications related to cannulation [ 14 , 15 ]. Prior to instrumentation of the CS, imaging allows for the identification of anatomic variants that may preclude the use of retrograde cardioplegia such as a persistent left superior vena cava, Thebesian valve [ 16 , 17 ], atrial septal defect or sinus venosus defect [ 18 ], Chiari network [ 2 ], or anomalous great cardiac venous drainage [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Transesophageal echocardiographic imaging of the coronary sinus: a retrospective analysis of mid-esophageal views and a novel transgastric view

et al. 2022

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Background Transesophageal echocardiographic imaging plays an important role in assessing coronary sinus anatomy prior to placement of a retrograde cardioplegia cannula. The coronary sinus can be imaged in the long axis by advancing the TEE probe from the mid-esophageal 4-chamber view or using a modified mid-esophageal bicaval view, while a short axis view can be obtained in the mid-esophageal 2-chamber view. While use of a transgastric view is only briefly mentioned in the literature as an alternative to mid-esophageal views, the authors commonly include it in our comprehensive transesophageal echocardiographic exam of the coronary sinus. This study examines the various imaging strategies. We hypothesize that the transgastric view offers comparable coronary sinus imaging to the mid-esophageal views. Methods After approval by our institutional review board, the intraoperative transesophageal echocardiographic exams for 50 consecutive elective cardiac surgical patients with a comprehensive echocardiographic assessment of the coronary sinus were retrospectively reviewed and analyzed to evaluate imaging of the coronary sinus in the various views. For each view, we noted and recorded if the coronary sinus and coronary sinus cannula were visualized. Statistical analysis required pairwise comparisons between each of the 4 views. P values were calculated using McNemar’s Exact test. Results Both the coronary sinus and coronary sinus cannula were visualized a majority of the time for each view. There was no statistically significant difference between each view in its ability to visualize the coronary sinus, nor was there a statistically significant difference between each view in its ability to visualize the coronary sinus cannula. Conclusions Use of a transgastric window provides the echocardiographer with an effective alternate modality for imaging the coronary sinus when mid-esophageal views are limited.

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