Retrograde Coronary Sinus Perfusion: A New Approach to Cardioplegia Delivery

1990 ◽  
Vol 1 (1) ◽  
pp. 59-64
Author(s):  
Sheri Monsein ◽  
Patria Constancia
Keyword(s):  
Cardiac Surgery ◽  
Coronary Sinus ◽  
Aortic Root ◽  
Patient Population ◽  
New Approach

Retrograde coronary sinus perfusion is a technique being used to deliver cardioplegia during cardiac surgery. This article reviews the history behind its use, the procedure for delivery, and the advantages and limitations that exist in comparison with the standard antegrade infusion of cardioplegia via the aortic root. The complications resulting from the technique of retrograde coronary sinus perfusion are rare. Nursing considerations specific to the potential complications of this patient population are discussed.

Inadvertent transseptal puncture into the aortic root: the narrow edge between luck and catastrophe in interventional cardiology

EP Europace ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1106-1115 ◽  
Author(s):  
Hao Chen ◽  
Thomas Fink ◽  
Xianzhang Zhan ◽  
Minglong Chen ◽  
Lars Eckardt ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Sinus ◽  
Aortic Root ◽  
Right Atrium ◽  
Surgical Repair ◽  
Clinical Course ◽  
Interventional Cardiology ◽  
Ascending Aorta ◽  
Transseptal Puncture ◽  
The Right

Aims Inadvertent puncture of the aortic root (AR) is a well-known complication of transseptal puncture (TSP). Strategies for handling of this potentially lethal complication have not been identified yet. In this study, we present typical anatomical locations and clinical management of aortic root puncture (ARP) due to TSP. Methods and results All patients with ARP were retrospectively collected from seven hospitals. Aortic root puncture was identified and classified regarding angiographical and intraoperative findings in cardiac surgery: (i) TSP from the right atrium (RA) to the non-coronary sinus (NCS), (ii) TSP from RA to the non-coronary sinutubular junction (STJ), and (iii) TSP from RA to the ascending aorta (AA). A total of 24 patients with inadvertent ARP were identified. In 19 patients, penetration of the aorta was accomplished by the inner dilator, in 5 patients by the complete sheath. Previous cardiac surgery had been performed in six patients. There were 13 RA-to-NCS punctures, 2 RA-to-STJ punctures, and 9 RA-to-AA punctures. No cardiac tamponade (CT) occurred in patients with RA-to-NCS and RA-to-STJ punctures. In 8 of 9 patients with RA-to-AA puncture, CT occurred immediately requiring urgent pericardiocentesis and surgical repair. Two patients died after surgical repair. In the 16 patients without surgical therapy, no shunt from the AR to the RA was observed 3 months after the procedure. Conclusion Aortic root puncture due to mislead TSP via NCS or STJ is usually not associated with a severe clinical course while ARP into the AA via the epicardial space generally leads to CT requiring surgical repair.

EFFECT OF THE POSITION OF THE CORONARY SINUS ORIFICE ON AORTIC LEAFLET COAPTATION

2014 ◽  
Vol 14 (06) ◽  
pp. 1440009
Author(s):  
YOULIAN PAN ◽  
AIKE QIAO ◽  
NIANGUO DONG
Keyword(s):  
Aortic Valve ◽  
Coronary Sinus ◽  
Aortic Root ◽  
Computational Simulation ◽  
Aortic Leaflet ◽  
Left And Right ◽  
Leaflet Coaptation ◽  
Geometric Relationship ◽  
2D And 3D ◽  
Sinus Pressure

Background: The various components of the aortic root maintain a particular geometric relationship to guarantee unobstructed blood flow across the aortic valve and valve competence. Objective: To quantify the effect of the position of the coronary sinus orifice (CSO) on aortic leaflet coaptation. Methods: 2D and 3D finite element models of an aortic valve and root were constructed, with the CSO located on the bottom and middle of the sinuses. ADINA fluid-structure interaction solver was employed to perform computational simulation. Results: The mean sinus pressure with left and right CSO was 1.02E+4 Pa and 1.03E+4 Pa, respectively, and the average leaflet pressure with left and right CSO was 1.06E+4 Pa and 1.05E+4 Pa, respectively, for the model with CSO located in the middle and bottom of the sinus. The leaflet summit displacement differences of the CSO position on the bottom and middle between left and right coronary sinuses and none were 11.56, -107.57, 16.17 and -92.86 μm, respectively. Conclusions: The position of the CSO affects the pressure distribution of the aortic root. The local high pressure results in symmetrical deformation of the three leaflets, and decreases the risk of leaflet mismatch in coaptation.

scholarly journals “Sleeve” Sinus Valsalva Repair in Patients with Acute Type A Aortic Dissection

2020 ◽  
Author(s):  
Laichun Song ◽  
Yang Gao ◽  
Ming Xu ◽  
Bo Wang ◽  
Xiaoyong Li ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Aortic Dissection ◽  
Coronary Sinus ◽  
Computed Tomography Angiography ◽  
Aortic Root ◽  
Acute Type ◽  
Sinus Of Valsalva ◽  
Type A Aortic Dissection ◽  
Left And Right

Purpose. The optimal surgical strategy of aortic root in acute type A aortic dissection (ATAAD) is controversial. The aim of this study was to evaluate the feasibility and safety of “Sleeve” sinus Valsalva repair for AAD limited to the non-coronary sinus or partial left and right coronary sinus without involvement coronary artery ostia. Methods: From Sep 2016 to Mar 2019, 20 patients with AAD involving non-coronary sinus or partial left and right coronary sinus Valsalva underwent “Sleeve” sinus Valsalva repair . Multi slice spiral computed tomography angiography (MSCT) and three dimensional reconstruction were routinely performed in all patients to assess the maximal diameters of each segment of the aorta. Results. There was no early death in hospital and one death during the 30-day postoperative period. Re-thoracotomy due to bleeding was necessary in only 1 patient and no bleeding was related to the proximal anastomosis. The post-operative drainage was 390.5±229.3mL. During the following-up, the echocardiography showed the normal sinus of Valsalva and aortic valvular function. The computed tomography angiography showed normal aortic root without endovascular leak or dissection around the sinus of Valsalva. All patients were free from reoperation. Conclusions. “Sleeve” sinus Valsalva repair with Dacron patch for aortic dissection limited to the non-coronary sinus or partial left and right coronary sinus without involvement coronary artery ostia was technically feasible and safe.

scholarly journals Endothelial glycocalyx during early reperfusion in patients undergoing cardiac surgery

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251747
Author(s):  
Arie Passov ◽  
Alexey Schramko ◽  
Ulla-Stina Salminen ◽  
Juha Aittomäki ◽  
Sture Andersson ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heparan Sulfate ◽  
Coronary Sinus ◽  
Heart Surgery ◽  
Coronary Circulation ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Open Heart Surgery ◽  
Endothelial Glycocalyx ◽  
Early Reperfusion

Background Experimental cardiac ischemia-reperfusion injury causes degradation of the glycocalyx and coronary washout of its components syndecan-1 and heparan sulfate. Systemic elevation of syndecan-1 and heparan sulfate is well described in cardiac surgery. Still, the events during immediate reperfusion after aortic declamping are unknown both in the systemic and in the coronary circulation. Methods In thirty patients undergoing aortic valve replacement, arterial concentrations of syndecan-1 and heparan sulfate were measured immediately before and at one, five and ten minutes after aortic declamping (reperfusion). Parallel blood samples were drawn from the coronary sinus to calculate trans-coronary gradients (coronary sinus–artery). Results Compared with immediately before aortic declamping, arterial syndecan-1 increased by 18% [253.8 (151.6–372.0) ng/ml vs. 299.1 (172.0–713.7) ng/ml, p < 0.001] but arterial heparan sulfate decreased by 14% [148.1 (135.7–161.7) ng/ml vs. 128.0 (119.0–138.2) ng/ml, p < 0.001] at one minute after aortic declamping. There was no coronary washout of syndecan-1 or heparan sulfate during reperfusion. On the contrary, trans-coronary sequestration of syndecan-1 occurred at five [-12.96 ng/ml (-36.38–5.15), p = 0.007] and at ten minutes [-12.37 ng/ml (-31.80–6.62), p = 0.049] after reperfusion. Conclusions Aortic declamping resulted in extracardiac syndecan-1 release and extracardiac heparan sulfate sequestration. Syndecan-1 was sequestered in the coronary circulation during early reperfusion. Glycocalyx has been shown to degrade during cardiac surgery. Besides degradation, glycocalyx has propensity for regeneration. The present results of syndecan-1 and heparan sulfate sequestration may reflect endogenous restoration of the damaged glycocalyx in open heart surgery.

Thoracoscopic surgery: a new approach to pulmonary disease

1996 ◽  
Vol 16 (2) ◽  
pp. 76-82
Author(s):  
T Shawgo
Keyword(s):  
Pulmonary Disease ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Patient Population ◽  
Surgical Procedure ◽  
Thoracoscopic Surgery ◽  
Disease Diagnosis ◽  
Invasive Approach ◽  
New Approach ◽  
Less Invasive Approach

VATS offers numerous advantages for patients with pulmonary disease. Diagnosis and management of numerous pulmonary and other thoracic conditions can now be treated with a less invasive approach. Because of this advance in technology, the ICU patient population is changing. With this advance, there will be fewer thoracotomies performed, resulting in fewer ICU admissions. Thoracoscopy offers hope for those critically ill patients who cannot withstand a diagnosis or interventional surgical procedure to treat their illness.

Impact of the patient population on the risk for heparin-induced thrombocytopenia

Blood ◽  
2000 ◽  
Vol 96 (5) ◽  
pp. 1703-1708 ◽  
Author(s):  
Theodore E. Warkentin ◽  
Jo-Ann I. Sheppard ◽  
Peter Horsewood ◽  
Patricia J. Simpson ◽  
Jane C. Moore ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Orthopedic Surgery ◽  
Odds Ratio ◽  
Patient Population ◽  
Cardiac Patients ◽  
Igg Antibodies ◽  
Heparin Induced Thrombocytopenia ◽  
Antigen Assay ◽  
Activation Assay ◽  
Orthopedic Patients

Abstract The frequency of immune heparin-induced thrombocytopenia (HIT) varies among prospective studies. It is unknown whether this is caused by differences in the heparin preparations, the patient populations, or the types of serologic assay used to confirm the diagnosis. Seven hundred forty-four patients were studied from 3 different clinical treatment settings, as follows: unfractionated heparin (UFH) during or after cardiac surgery (n = 100), UFH after orthopedic surgery (n = 205), and low-molecular-weight heparin (LMWH) after orthopedic surgery (n = 439). Both an activation assay and an antigen assay were used to detect heparin-dependent IgG (HIT-IgG) antibodies. By activation assay, the frequency of HIT-IgG formation ranged from a low of 3.2% in orthopedic patients receiving LMWH to a high of 20% in cardiac patients receiving UFH; by antigen assay, the corresponding frequencies ranged from 7.5% to 50%. Both UFH use (P = .002) and cardiac surgery (P = .01) were more likely to be associated with HIT-IgG formation. However, among patients in whom HIT-IgG formed and who were administered UFH, the probability for HIT was higher among orthopedic patients than among cardiac patients (by activation assay: 52.6% compared with 5%; odds ratio, 21.1 [95% CI, 2.2-962.8]; P = .001; by antigen assay: 34.5% compared with 2.0%; odds ratio, 25.8 [95% CI, 3.2-1141]; P &lt; .001). It is concluded that there is an unexpected dissociation between the frequency of HIT-IgG formation and the risk for HIT that is dependent on the patient population. HIT-IgG antibodies are more likely to form in patients who undergo cardiac surgery than in orthopedic patients, but among patients in whom antibodies do form, orthopedic patients are more likely to develop HIT.

Bioconduit subannular implantation for aortic root endocarditis after previous cardiac surgery: Results from two Italian centers

2020 ◽  
Vol 35 (11) ◽  
pp. 3041-3047
Author(s):  
Mariano Cefarelli ◽  
Giovanni Concistrè ◽  
Luca Montecchiani ◽  
Giacomo Bianchi ◽  
Paolo Berretta ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Root

A new approach to percutaneous coronary revascularization in patients requiring undeferrable non-cardiac surgery

2011 ◽  
Vol 146 (3) ◽  
pp. 399-403 ◽  
Author(s):  
Federico Piscione ◽  
Salvatore Cassese ◽  
Gennaro Galasso ◽  
Plinio Cirillo ◽  
Giovanni Esposito ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Revascularization ◽  
New Approach ◽  
Percutaneous Coronary Revascularization ◽  
Percutaneous Coronary
Sign in / Sign up

Export Citation Format

Share Document