Iatrogenic Injuries during Retrograde Delivery of Cardioplegia- Prevention, Diagnosis and Management: A Collective Review

Authors: Sankhyan LK, Chowdhury UK*, George N, Chauhan A, Singh S, Gudala VB, Gupta AK and Hasija S

DOI: 10.23880/oajc-16000142

Volume 3, Issue 1

Abstract

The causative factors and morphologic spectrum of iatrogenic coronary sinus injuries during retrograde delivery of cardioplegia through the coronary sinus are many and varied. In this review, we give an account of all cases previously described as iatrogenic injuries of the coronary sinus, analyzing in detail those cases where an accurate anatomical description of the injuries was provided. We identified 27 investigations and reviewed the anatomic variations of the coronary sinus, causative mechanisms of injury to the coronary sinus, diagnostic features, intraoperative findings and management of the patients described. Transesophageal echocardiography, contrast injection into the coronary sinus and intraoperative identification of the catheter tip perforation of the inner wall of the coronary sinus, transmural migration and eventual perforation or laceration of the right ventricle and hemodynamic or pressure tracing of the coronary sinus identified these injuries involving the coronary sinus and its tributaries. We have grouped the injuries into categories that have a bearing on the appropriate surgical approach, discussing the appropriate repair for each group. We submit that an increased appreciation of various types of iatrogenic coronary sinus injuries may well contribute to its prevention and improved future surgical management.

Keywords: Coronary Sinus Injuries; Coronary Sinus Laceration; Myocardial Preservation; Retrograde Cardioplegia

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