Identification of Coronary Sinus Injury by Transesophageal Echocardiography During Placement of a Retrograde Cardioplegia Catheter for Minimally Invasive Cardiac Surgery

Objective To perform minimally invasive cardiac surgery through the smallest possible wound and with the least number of incisions in the heart or aorta, the necessary cannulations to undergo cardiopulmonary bypass must be done through peripheral vessels. A difficult skill to learn for the cardiac anesthesiologist is how to safely and efficiently position the coronary sinus catheter (Endoplege; Edwards Lifesciences LLC, Irvine, CA USA) required for retrograde cardioplegia administration. Methods In patients in whom a Swan-Ganz catheter was inserted as part of the operative management strategy for non–minimally invasive heart surgery, we have been using it as a training tool to learn how to visualize and manipulate right-sided catheters under transesophageal echocardiography. We developed this teaching technique to help hone some of the necessary skills needed to place the Endoplege catheter for minimally invasive cardiac surgery. Manipulation was done with the goal of visualizing the catheter and guiding it into the coronary sinus. For a 4-month period, anesthesia records were retrospectively reviewed. Results Fifteen patients, for a total of 19 catheter manipulations, were found in whom we had documented the use of the Swan-Ganz catheter and details about the insertion as a training tool. The coronary sinus and the catheter were visualized 100% of the time. The Swan-Ganz catheter was successfully inserted into the coronary sinus in 17 of 19 catheter manipulations. Conclusions The Swan-Ganz catheter can be used as a training tool to develop some of the necessary skills to place catheters into the coronary sinus with transesophageal echocardiography guidance.

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Cannulation of the Middle Cardiac Vein during MICS

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e318254dfb6 ◽

2012 ◽

Vol 7 (1) ◽

pp. 62-64

Author(s):

Enrique J. Pantin ◽

Jonathan L. Kraidin ◽

Steven H. Ginsberg ◽

John T. Denny ◽

Alann R. Solina

Keyword(s):

Cardiac Surgery ◽

Minimally Invasive ◽

Coronary Sinus ◽

Minimally Invasive Cardiac Surgery ◽

Catheter Placement ◽

Venous Anatomy ◽

Retrograde Cardioplegia ◽

Coronary Sinus Catheter ◽

Cardiac Surgeon ◽

Middle Cardiac Vein

Coronary sinus cannulation for retrograde cardioplegia administration during cardiac surgery is common practice. Several of the cannulas that are placed by the cardiac surgeon on open procedures are now placed by the cardiac anesthesiologist during minimally invasive cardiac surgery, including the coronary sinus catheter. The understanding of the cardiac venous anatomy is very important during coronary sinus catheter placement. We present a case where a percutaneously placed coronary sinus catheter was inadvertently placed into the middle cardiac vein but detected with the use of fluoroscopy.

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