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Synchronized coronary sinus retroperfusion (SCSR) 381-388, 1986. THE CONCEPT OF perfusing the heart via the coronary sinus is based on the observation that the coronary venous system is not affected by the atherosclerotic process . 1 It has been known since the late 1 800s5 that myocardial viability in animals can be maintained through retrograde flow of oxygenated blood via the coronary sinus. In the late 1940s, Beck and his colleagues6',7 demonstrated that shunting of arterialized blood to the coronary venous system could relieve angina in patients with chronic coronary artery disease. The major limitation of surgical retroperfusion was the inadequacy of venous drainage, which led to engorgement of the coronary sinus, myocardial edema, and heart failure. Beck's operation was superceded by direct myocardial revascularization with saphenous vein grafts, a more physiologically appealing

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