Coronary sinus rupture with retrograde cardioplegia

Abstract

Coronary sinus (CS) rupture occurring during retrograde cardioplegia (RCP) is a rare complication. Patients with left ventricular hypertrophy are at higher risk for injury to the CS. The patient was a 66-year-old female with hypertension, ischemic cardiomyopathy and dysrhythmias, who had evidence of an anterior wall myocardial infarction, congestive heart failure and angina. During coronary artery bypass surgery, antegrade cardioplegia was initially administered, but aortic insufficiency prevented adequate myocardial cooling. RCP was then administered and the heart cooled appropriately. After approximately 300 ml of blood cardioplegic solution had been given, the CS pressure suddenly dropped from 30 mmHg to zero. RCP administration was stopped, and the surgeon palpated a hematoma over the area of the CS, which later ruptured upon rotation of the heart. A primary repair could not be performed, so a pericardial patch was placed over the area of disruption, which appeared to provide adequate hemostasis. The patient was weaned from cardiopulmonary bypass (CPB), but began to bleed freely from the CS distal to the pericardial patch. The patient was placed back on CPB to allow further repair of the CS, but the tissues were thin and friable and the ventricle disassociated from the ventricular septum. The situation was deemed not salvageable and further attempts at repair were stopped. The perfusionist should monitor infusion pressures and the CS waveform during RCP delivery. Changes in the waveform may indicate cannula malposition, loss of balloon seal, or, more rarely, CS rupture; such changes should prompt immediate cessation of RCP delivery.

Lower retention after retrograde coronary venous infusion compared with intracoronary infusion of mesenchymal stromal cells in the infarcted porcine myocardium

“…It is also possible that pericardial fluid collection and haematoma formation were related to CS injury in some of the cases. Contrary to RCVI studies, development of haematomas on the atrioventricular groove, pericardial fluid collections and damage to the CS have been reported in the field of cardiac surgery and have been related to traumatic catheter insertion, overinflation of the balloon in the CS and elevated CS infusion pressure during retrograde cardioplegia 27–30. With retrograde cardioplegia, the CS is accessed with a balloon-catheter to occlude the CS and subsequently infuse fluid to arrest the heart and protect the myocardium.…”

Percutaneous Coronary Sinus Catheter Placement Aided by 3-Dimensional Transesophageal Echocardiography

“…Injuries to the coronary sinus have occurred with a wide variety of instruments, such as guidewires, angioplasty catheters, balloon inflation, and by surgeons directly placing coronary sinus catheters. 3,4 In addition to 2-D imaging, real-time 3-D echocardiography has been used to guide a variety of catheter-based cardiac interventions including atrial septal occlusion, mitral balloon valvuloplasty, ventricular septal defect closure, and others. 5 In this study, we present a case in which 3-D imaging facilitated placement of a percutaneous coronary sinus catheter.…”

Coronary sinus perforation during reducer implantation

“…CS rupture is extremely rare. Most of the reported cases in the scientific literature occurred during retrograde cardioplegia, with none resulted in patients' death . Sabzi et al in a retrospective analysis found female gender and low body mass index as potential predicting factors for CS rupture ; in their population the incidence for CS rupture was 1.02% (15 patients of 1,465).…”

“…Coronary sinus (CS) perforation is a very rare event, described as infrequent complication of certain cardiac surgery procedures, such as coronary sinus perfusion catheter placement for retrograde cardioplegia , or during CS lead implantation or extraction . Other few cases reported in literature are anecdotic, and even more rare .…”