Occluding the Junction of the Middle Cardiac Vein in Retrograde Cardioplegia: A New Retrograde Cannula for Optimizing Retrograde Cardioplegic Delivery

Abstract

Retrograde cardioplegia often fails to provide adequate perfusion of the right ventricle and the posterior wall of the left ventricle because of the shunt through the thebesian vein. However, much of the retrograde cardioplegic solution may leak into the right atrium after veno-venous anastomoses at the apex of the heart, especially when a retrograde balloon cannula is inserted too deeply in the great cardiac vein, although this is not widely recognized. We designed a new retrograde cardioplegic cannula with three self-inflating balloons, which reduced the shunt flow by occluding the junction of the middle cardiac vein and improving in cardioplegic delivery. We describe the myocardial dye distribution achieved by using this new cannula in pig hearts and report the results of its clinical application.

The New Delivery Method for Cardioplegic Solution in Type A Aortic Dissection

“…However, the limitation to the use of retrograde cardioplegia is the risk of coronary sinus rupture, inadequate protection of the right ventricle, and the posterior wall of the left ventricle due to shunting of the solution through the Thebesian veins and connections between the great cardiac vein and the anterior cardiac vein, due to deep insertion of the cannula into the coronary sinus below the confluence of the large cardiac vein. 4 Our proposed method of delivering cardioplegic solution using a Foley catheter through the orifice of the brachiocephalic trunk or the left common carotid artery allows us to avoid the above "pitfalls" of myocardial protection in type A aortic dissection. The only limitation of the method is the impossibility of its use in moderate and severe aortic valve insufficiency.…”

“…However, the limitation to the use of retrograde cardioplegia is the risk of coronary sinus rupture, inadequate protection of the right ventricle, and the posterior wall of the left ventricle due to shunting of the solution through the Thebesian veins and connections between the great cardiac vein and the anterior cardiac vein, due to deep insertion of the cannula into the coronary sinus below the confluence of the large cardiac vein. 4 …”